Protective effects of antireflux surgery on lung function in patients with interstitial lung disease

Interstitial lung disease (ILD) is a debilitating and progressive process whose etiology is not completely understood. Correlations between gastroesophageal reflux disease and ILD have been established, with studies suggesting that microaspiration of gastric contents may perpetuate the disease process. Early data suggest that antireflux surgery may prevent disease progression and decrease frequency of exacerbations. We hypothesize that antireflux surgery is safe and effective in patients with interstitial lung disease and that it may positively impact lung function.

We performed a retrospective review on prospectively collected data of all patients who underwent antireflux surgery in the setting of ILD at a single academic institution between 2021 and 2024. Primary endpoints include 30-day readmission, mortality, and postoperative complications. Secondary endpoints included postoperative reported reflux symptoms, and preoperative and postoperative pulmonary function tests.

Thirty-five (35) patients with a history of ILD underwent antireflux surgery. The majority of patients underwent robotic hiatal hernia repair with Toupet (270°) fundoplication. There were two 30-day readmissions. One patient required EGD with dilation for postoperative dysphagia. There were no mortalities at 1 year. The majority of patients (n = 26, 74%) reported complete resolution of reflux. Postoperative FVC values and percent predicted FVC were significantly higher than preoperative values (2.29 ± 0.8 versus 2.13 ± 0.6, p = 0.01) (65.4% ± 18 versus 61.3% ± 17, p = 0.001). Postoperative FEV1 levels were greater than preoperative levels (1.9 ± 0.6 versus 1.7 ± 0.5, p = 0.01). Percent predicted FEV1 also significantly improved after surgery (68.2% ± 20 versus 63.4 ± 19, p = 0.007). Post and preoperative DLCO remained unchanged (10.0 ± 2.4, 9.9 ± 2.8, p = 0.9).

Robot-assisted laparoscopic antireflux surgery appears to be a safe method for reflux control in patients with interstitial lung disease and can help to stabilize or even improve lung function at short-term follow-up.