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Etiologic factors in long-term respiratory function abnormalities following esophageal atresia repair
P N LeSouëf1, N A Myers, L I Landau
1Department of Thoracic Medicine, Royal Children's Hospital, Parkville, Victoria, Australia.
Insights
Infants undergoing esophageal atresia repair may develop long-term lung damage, particularly if they had pneumonia. Lower esophageal sphincter incompetence and gastroesophageal reflux were not linked to respiratory issues in this study.
Area of Science:
- Pediatric Surgery
- Pulmonology
- Gastroenterology
Background:
- Recurrent respiratory illnesses are common in infants after esophageal atresia repair.
- Functional gastrointestinal and respiratory abnormalities persist in older children.
- The link between gastrointestinal and respiratory mechanics requires further investigation.
Purpose of the Study:
- To investigate the association between lower esophageal sphincter (LES) incompetence, gastroesophageal reflux (GER), and respiratory function abnormalities.
- To evaluate long-term respiratory outcomes in patients following esophageal atresia repair.
Main Methods:
- Studied 18 patients (age 12-21) post-esophageal atresia repair (Vogt type 111B).
- Assessed spirometry, lung volumes (plethysmography), esophageal manometry (LES pressure, motility), and esophageal pH monitoring (GER).
- Grouped subjects based on pneumonia history in the first 4 years.
Main Results:
- Mildly decreased lung volumes were observed in the group with a history of pneumonia.
- No significant association was found between respiratory function abnormalities and abnormal LES pressure or GER.
- Pneumonia in infancy appears linked to mild, long-term lung damage.
Conclusions:
- Pneumonia in infants with esophageal atresia is associated with mild long-term lung damage.
- Lower esophageal sphincter dysfunction and GER do not seem to be major contributors to respiratory problems in this population.
- Further research may explore other factors influencing respiratory outcomes.
Abstract:
Recurrent respiratory illnesses are frequent in infants following repair of esophageal atresia and functional abnormalities of respiratory and esophageal function are often seen in older children. Recurrent aspiration is a potential cause of these respiratory abnormalities, but a relationship between abnormalities of gastrointestinal and respiratory mechanics has not been adequately investigated. We sought an association between lower esophageal sphincter (LES) incompetence, gastroesophageal reflux (GER), and respiratory function abnormalities in 18 subjects (age 12 to 21 years) following repair of esophageal atresia (Vogt type 111B). In each subject, measurements were made of spirometry, lung volumes assessed by plethysmography, esophageal manometry recorded using a constantly infused fluid-filled trilumen catheter to assess LES pressure and esophageal motility, and esophageal pH monitoring to detect GER. Subjects were grouped according to the presence or absence of a radiologically supported diagnosis of pneumonia in the first 4 years of life. Lung volumes were mildly but significantly decreased in the "pneumonia" group compared with the "nonpneumonia" group. There was no association between abnormalities of respiratory function and abnormal LES pressure or the presence of GER. These data suggest that pneumonia in esophageal atresia infants is associated with mild long-term lung damage. LES dysfunction and GER do not appear to play a major role in this process.