Treatment of Bronchiolitis Obliterans in Lung Transplant Recipients with Gastro-oesophageal Reflux Disease and Declining FEV1

Lung transplant recipients who develop a decline in FEV1 consistent with bronchiolitis obliterans syndrome (BOS) and who have confirmed gastro-oesophageal reflux represent a distinct clinical subgroup. The coexistence of confirmed gastro-oesophageal reflux disease (GORD/GERD) directly informs the management approach in this population.

Clinical Scenario

Lung transplant recipients with a decline in FEV1 consistent with the onset of bronchiolitis obliterans syndrome and confirmed gastro-oesophageal reflux. Both conditions must be present for this protocol to apply.

Gastro-oesophageal reflux disease

Management Approach — partial overview

In this scenario, management centres on a surgical referral for specialist evaluation of an intervention directed at the gastro-oesophageal junction. The full protocol specifies the referral pathway, the surgical evaluation criteria, and the evidence basis — including the grade and quality of the underlying recommendation.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1183/09031936.00107514

For lung transplant recipients who develop a decline in FEV1 consistent with the onset of BOS and have confirmed GOR, we suggest referral to an experienced surgeon to be evaluated for potential fundoplication of the gastro-oesophageal junction (conditional recommendation, very low quality evidence).

Nissen fundoplication has been more extensively studied than Toupet fundoplication; however, we have no reason to believe that one is superior to the other and feel that the choice of the surgical technique should remain at the surgeon's discretion.

View source ↗