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[Motor function of the esophagus following surgery for atresia]
L Gorostiaga Ganzarain1, J A Tovar Larrucea, J Arana García
1Departamento de Sanidad, Universidad del País Vasco.
Insights
Gastroesophageal reflux (GER) is common in children treated for esophageal atresia (EA), often causing digestive and respiratory issues. Surgical anti-reflux procedures are effective for managing GER in these patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Esophageal Disorders
Background:
- Esophageal atresia (EA) is a congenital condition requiring surgical correction.
- Long-term complications, including gastroesophageal reflux (GER), are frequent after EA repair.
Purpose of the Study:
- To evaluate the incidence and impact of GER in survivors of EA treated with neonatal end-to-end anastomosis.
- To assess esophageal function and mucosal integrity in EA patients with GER.
- To determine the efficacy of anti-reflux surgery in this population.
Main Methods:
- Retrospective study of 20 children treated for EA, with an average follow-up of 111 months.
- Clinical assessment for digestive and respiratory symptoms of GER.
- Esophageal pH monitoring and manometry.
- Histological examination for esophagitis and Barrett's esophagus.
- Review of outcomes after anti-reflux procedures.
Main Results:
- 16 survivors from 20 EA patients studied.
- 12 survivors (75%) experienced GER, presenting with digestive or respiratory symptoms.
- pH studies revealed significantly increased acid exposure.
- Manometry showed disorganized peristalsis and absent propulsive waves.
- Histological findings included esophagitis in 5 and Barrett's esophagus in 2 patients.
- 7 patients underwent anti-reflux surgery with positive outcomes.
Conclusions:
- GER is highly prevalent in EA survivors and significantly impairs esophageal function.
- Esophageal mucosal lesions can be severe.
- Fundoplication is an effective surgical treatment for GER in EA patients.
- Given the structural anomalies, spontaneous improvement is unlikely; surgical intervention is often indicated.
- Long-term gastro-enterologic follow-up is essential for EA patients.
Abstract:
We have studied for periods averaging 111 months 16 survivors out of a series of 20 children treated for oesophageal atresia (EA) by neonatal end-to-end anastomosis. Twelve of them had gastroesophageal reflux (GER) manifested by either digestive (vomiting, dysphagia, pyrosis, haemorrhage or foreign body impaction) or respiratory symptoms (repeated neumoniae or frequent u.r.i.). pH-studies decealed very increased acid exposure in these patients. Manometric studies showed disorganized peristalsis with near-absence of propulsive waves and predominance of mass-contractions. Interestingly both lower esophageal sphincter pressure and length were normal. Five children had histological esophagitis and 2 had Barrett's esophagus. Seven patients have had an anti-reflux procedure and two more should be operated in the near future. Our experience reveals that GER incidence in EA is very high, that esophageal function is severely impaired in this condition, that mucosal lesions can be serious and that funduplication is effective. Since it has been demonstrated that esophageal dysfunction in EA patients is due to structural anomalies, spontaneous improvement should not be expected in them and surgical treatment should be largely indicated. EA patients require long-term gastro-enterologic follow-up.