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Effect of trisomy 21 on long-term gastrointestinal outcomes in duodenal atresia
Anna Zrinyi1, Suyin A Lum Min1, Emmanuel A Bello1
1Department of Surgery, Division of Pediatric Surgery, University of Manitoba, and Children's Hospital Research Institute of Manitoba, AE402-820 Sherbrook Street, Winnipeg, MB, R3A 1S1, Canada.
Insights
Trisomy 21 (T21) increases esophageal and gastric issues in children with duodenal atresia (DA). However, T21 did not significantly impact ulcerative or obstructive gastrointestinal complaints in these DA cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Genetics
Background:
- Duodenal atresia (DA) is a congenital obstruction requiring surgical repair.
- Trisomy 21 (Down syndrome) is a common genetic condition associated with various congenital anomalies, including gastrointestinal issues.
Purpose of the Study:
- To investigate the impact of Trisomy 21 (T21) on gastrointestinal (GI) outcomes in pediatric patients diagnosed with duodenal atresia (DA).
Main Methods:
- A retrospective cohort study identified children with DA between 1991 and 2017.
- Cases were stratified into DA with T21 and DA without T21, with 10 healthy controls per case.
- Gastrointestinal outcomes including esophageal, ulcerative, obstructive, and stomach complaints were assessed using risk ratios, rate ratios, and Cox models.
Main Results:
- Children with DA experienced more GI complaints compared to controls.
- DA cases with T21 showed a significantly higher risk and frequency of esophageal disease (RR=4.08, p=0.002) and gastric complaints (RaR=6.20, p<0.001) compared to non-T21 DA cases.
- T21 did not significantly alter the risk of obstruction or ulcerative diseases in DA patients, though obstructive symptoms were reported less frequently in T21 cases.
Conclusions:
- Duodenal atresia is associated with increased gastrointestinal morbidity.
- Trisomy 21 exacerbates esophageal and gastric symptoms in children with duodenal atresia.
- The presence of T21 does not appear to influence the occurrence of ulcerative or obstructive GI issues in DA patients.
Purpose:
We aimed to determine if Trisomy 21 (T21) affected gastrointestinal outcomes for children with duodenal atresia (DA).
Methods:
We identified children born with DA between 1991 and 2017. Cases were divided into DA with T21 and DA without T21. Ten healthy controls per case were included. Esophageal, ulcerative, obstructive and stomach complaints were assessed. Risk ratios (RR), rate ratios (RaR) and Cox models were constructed. Analyses were performed for cases versus controls, and for T21 cases versus non-T21 cases.
Results:
DA cases totaled 52: 22 had T21 and 30 did not. There were 520 controls. DA cases had more gastrointestinal complaints than controls. T21 cases were at greater risk and frequency of esophageal disease than non-T21 cases (RR = 4.08, p = 0.002, RaR = 69.8, p < 0.001). T21 and non-T21 cases were equally likely to present with obstruction (RR = 0.91, p = 1), but T21 cases complained of obstructive symptoms less (RaR = 0.57, p = 0.003). T21 and non-T21 cases had the same risk of stomach diseases, but T21 cases complained more frequently (RaR = 6.20, p < 0.001). Cox models supported these observations. T21 did not affect ulcerative diseases.
Conclusion:
DA cases had more gastrointestinal problems than controls. T21 increased esophageal and gastric complaints in DA cases but did not affect ulcerative and obstructive complaints.
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