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Long-term evaluation of esophageal function in patients treated at birth for esophageal atresia
V Tomaselli1, M L Volpi, C A Dell'Agnola
1Department of Pediatric Surgery, Niguarda Ca' Granda Hospital, Milan, Italy. vpatom@libero.it
Insights
Long-term follow-up of patients treated for esophageal atresia (EA) with tracheoesophageal fistula (TEF) reveals esophageal dismotility as a primary consequence. While dysphagia is common, significant gastroesophageal reflux is less frequent.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Disorders
Background:
- Esophageal atresia (EA) with tracheoesophageal fistula (TEF) requires surgical correction in newborns.
- Long-term complications like dysphagia and gastroesophageal reflux (GER) are reported in EA/TEF survivors.
Purpose of the Study:
- To evaluate the long-term clinical outcomes in patients treated for EA/TEF at birth.
- To assess the incidence of dysphagia, GER, and esophageal functional abnormalities.
Main Methods:
- Clinical evaluation of 26 EA/TEF patients 8-28 years post-treatment.
- Utilized barium meal, upper GI endoscopy, 24-hour pH monitoring, and esophageal manometry.
Main Results:
- 50% experienced dysphagia; 20% had mild esophagitis; only 16.7% showed GER.
- Esophageal anomalies found in 31% via X-ray.
- 100% exhibited disorganized peristalsis; 58% had low amplitude contractions.
Conclusions:
- Esophageal dismotility is the predominant long-term consequence of EA/TEF.
- Despite dismotility, significant nutritional disturbances were not observed in this cohort.
Abstract:
Dysphagia, gastroesophageal reflux (GER) and esophageal metaplasia are reported with various incidence in the long term follow-up of patients treated at birth for esophageal atresia (EA). To evaluate the long term outcomes 26 patients treated at birth for EA with Tracheo Esophageal Fistula (TEF) were examined 8-28 (mean 15.8) years later by clinical evaluation, including barium meal, fiberoptic upper GI endoscopy, 24 hour ambulatory two-channel pH-monitoring and stationary esophageal manometry. 50% of patients complained of dysphagia. Mild esophagitis was found in 20% of patients but GER was detected in only 16.7% of the cases. By morphological X-ray, esophageal anomalies were detected in 31% of cases without significant functional relevance. Hundred percent of patients had a disorganized peristaltic esophageal activity and a low amplitude of the esophageal contractions was observed in 58% of them. In our series, esophageal dismotilty seems to be the main consequence of EA without any relevant disturbance of normal nutritional habit.
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