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Defective upper gastrointestinal function after repair of combined esophageal and duodenal atresia
Ana Catarina Fragoso1, Ruben Ortiz2, Francisco Hernandez2
1Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; INGEMM and Idipaz Research Laboratory, Department of Pediatrics, Universidad Autonoma de Madrid; Faculty of Medicine, University of Porto. Porto, Portugal.
Insights
Patients with both esophageal atresia (EA) and duodenal atresia (DA) experience significant upper digestive dysfunction, leading to high risks of gastroesophageal reflux disease (GERD) and surgical complications.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Congenital Malformations
Background:
- Esophageal atresia (EA) and duodenal atresia (DA) are congenital anomalies often associated with impaired anti-reflux mechanisms and esophageal motility.
- These conditions can lead to duodenogastric reflux, impacting upper gastrointestinal function.
Purpose of the Study:
- To evaluate the long-term upper gastrointestinal functional status in patients with the combined diagnosis of EA and DA.
- To assess the prevalence of gastroesophageal reflux disease (GERD) and the need for surgical intervention in this cohort.
Main Methods:
- Retrospective analysis of patients treated for EA and DA between 1965 and 2012.
- Assessment included clinical records, imaging, upper gastrointestinal endoscopy, and esophageal pH monitoring/impedance.
- Evaluation focused on long-term esophageal condition, GERD, and outcomes of surgical procedures.
Main Results:
- Of 581 EA patients, 20 had associated DA; 10 survived to adulthood.
- With a median follow-up of 9 years, 8 of 9 survivors experienced complicated outcomes, including GERD, eosinophilic esophagitis, gastritis, and surgical complications.
- Ten surgical procedures were performed, including 8 fundoplications, indicating significant management challenges.
Conclusions:
- The co-occurrence of EA and DA is linked to poor upper digestive function and a high risk of GERD.
- Fundoplication procedures in these patients have a high failure rate, necessitating lifelong monitoring and active treatment strategies.
Background:
Both esophageal atresia (EA) and duodenal atresia (DA) involve deficient anti-reflux barrier, poor esophageal function and eventually, duodenogastric reflux. This study aims at examining the upper gastrointestinal functional status in a cohort of patients with both EA and DA.
Methods:
A retrospective survey of patients treated for EA and DA between 1965 and 2012 was conducted. Clinical charts, office visits, imaging, upper gastrointestinal endoscopy and esophageal pH metry/impedance were used to assess the long-term condition of the esophagus, the presence of gastroesophageal reflux disease (GERD) and/or the need for fundoplication.
Results:
Twenty out of 581 patients treated for EA had associated DA. Ten/twenty children survived; 1 had primary esophageal replacement. With a median follow-up of 9 years, 8/9 had complicated outcomes and 5 still suffered digestive ailments: 2 GER; 1 eosinophilic esophagitis; 1 nodular gastritis, and 1 wrap herniation. A total of 10 procedures were performed: 8 fundoplications, 1 esophagogastric dissociation and 1 replacement with colon.
Discussion:
The association of EA with DA involves a poor upper digestive function with high risks of GERD and fundoplication failure. The lifelong synergistic play of esophageal, gastric and duodenal dysfunctions in these patients prompts long-term follow-up, and eventually active treatment.
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