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Lung function abnormalities in repaired oesophageal atresia and tracheo-oesophageal fistula
P Chetcuti1, P D Phelan, R Greenwood
1Department of Thoracic Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Minor lung function abnormalities are common after oesophageal atresia repair. Early management of gastro-oesophageal reflux may help improve lung function in these patients.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Gastroenterology
Background:
- Respiratory complications frequently occur post-neonatal repair of oesophageal atresia and tracheo-oesophageal fistula.
- The prevalence of lung function abnormalities and their link to gastrointestinal issues remains understudied in large patient cohorts.
Purpose of the Study:
- To investigate the prevalence of lung function abnormalities in patients who underwent surgical repair for oesophageal atresia and tracheo-oesophageal fistula.
- To explore the relationship between gastrointestinal complications and lung function in this population.
Main Methods:
- Lung volumes and flow-volume loops were assessed in 155 patients (aged 6-37 years) without spinal curvature, who had prior surgery for oesophageal atresia and tracheo-oesophageal fistula.
- Patients were evaluated for lower airways disease, restrictive lung disease, and signs of tracheal obstruction.
Main Results:
- Mild lower airways disease was observed in 64% of patients, with significant reductions in FEV1 (25%) and elevated RV/TLC ratios (41%).
- Restrictive lung disease was present in 18% of patients. Tracheal obstruction was noted in 50% of subjects.
- Gastro-oesophageal reflux in early childhood correlated with increased airway obstruction and reduced lung volumes.
Conclusions:
- Minor lung function abnormalities are prevalent following oesophageal atresia repair.
- Prompt diagnosis and management of gastro-oesophageal reflux may mitigate long-term lung function deficits.
Background:
Respiratory complications are common after neonatal repair of oesophageal atresia and tracheo-oesophageal fistula. The prevalence of lung function abnormalities and the relation between gastrointestinal complications and lung function has not been studied in a large number of patients.
Methods:
Lung volumes and flow-volume loops were measured in 155 patients without spinal curvature aged 6-37 years who had undergone surgery for oesophageal atresia and tracheo-oesophageal fistula.
Results:
Sixty four of the 155 patients had evidence of mild lower airways disease, with values for FEV1 more than two standardised scores below the predicted value in 39 (25%) and above 2 standardised scores for the residual volume (RV)/total lung capacity (TLC) ratio in 64 (41%). Restrictive lung disease (TLC more than 2 standardised scores below predicted) was present in 28 (18%). Severe lung function abnormalities were present in under 10% of the 155. Half the subjects had some evidence of extra-thoracic tracheal obstruction, with a high ratio of expiratory to inspiratory flow for peak flow in 76 (50%) and at 50% of vital capacity in 59 (38%). Patients with radiological gastro-oesophageal reflux in early childhood had more airways obstruction and smaller lung volumes. Patients with current gastrointestinal symptoms were similar in their lung function to symptom free patients.
Conclusions:
Minor lung function abnormalities are common in patients after repair of oesophageal atresia. Early diagnosis and management of gastro-oesophageal reflux may help to minimise these lung function abnormalities.