Long-term evaluation of esophageal and pulmonary function in patients with repaired esophageal atresia and tracheoesophageal fistula

Abstract

Patients who have undergone repair of esophageal atresia and tracehoesophageal fistula as infants have been noted to have residual esophageal dysmotility and pulmonary dysfunction during their childhood years. However, limited information is available about the long-term follow-up of these patients. In this study we performed esophageal and pulmonary function studies on 12 adults who had required surgical repair of these defects in the first week of life. Most patients had symptoms of dysphagia and heartburn at time of evaluation. Pathologic gastroesophageal reflux was documented in 67% of patients and esophagitis was noted in 34%. All patients had esophageal motility abnormalities characterized by low-amplitude nonperistaltic waves throughout most of the esophagus. In addition, although most patients had no respiratory symptoms, mild restrictive lung volumes were noted in many patients. However, airflow obstruction and airway hyperreactivity were not present. These data demonstrate that clinical symptoms and abnormal esophageal manometry and pulmonary function persist well into the third and beginning of the fourth decade after repair of esophageal atresia and tracheoesophageal fistula in infancy.

Repaired oesophageal atresia: respiratory morbidity and pulmonary function in adults

“…Nevertheless, decreased RSRQoL and daily respiratory symptoms were still significantly more common among patients than among controls. Incidences of asthma and BHR were in line with previous results, whereas the PF abnormalities were more common among our adults than in children and adolescents [9,14,18,20,21,36], in accordance with other findings among adults [19].…”

“…This is generally higher than in children (8.8%) [16] and adults (6%) [17]. Additionally, pulmonary function (PF) abnormalities, mostly mild restrictive disease [14,18,19], occur after repair of OA in childhood [14], adolescence [9,18,20,21] and adulthood [12,19,21]. Restriction may result from surgical trauma, repeated aspiration or recurrent chest infections, as well as from associated thoracic musculoskeletal defects, such as postoperative rib fusions, scoliosis or other chest deformities.…”

Esophageal motility in an adult with a congenital H-type tracheoesophageal fistula

“…Upper and lower esophageal sphincter pressure and function were normal. Biller and co-workers' findings were similar [10]. The primary abnormality detected was an overall decrease in the amplitude of contraction in the esophageal body with a lack of peristalsis in at least one portion of the esophagus in all patients.…”

Unilateral Bronchiectasis and Esophageal Dysmotility in Congenital Adult Tracheoesophageal Fistula.

“…Patients with congenital TEF have esophageal dysmotility. Its features are inefficient or absent peristalsis (8), reduced, or at times normal, lower esophageal sphincter pressure resulting in reflux and esophagitis (12), and a diminution in amplitude of contractions of the esophageal body (12). These findings maypersist even after the repair.…”

“…These findings maypersist even after the repair. Almost all the patients have postoperative absence of peristalsis in at least one segment of their esophagus (12). This absence, in conjunction with weakness of the lower esophageal sphincter, are commondenominators in patients without esophageal atresia (congenital Htype) (13).…”