Abstract
Objective For many years, esophageal atresia (EA) has been curable by surgery. However, severe
respiratory morbidity and gastroesophageal reflux (GER) symptoms remain a problem
in many patients. The purpose of this study was to describe respiratory and esophageal
morbidity, esophageal function, and lung function, including the small airways, in
patients with the most common type of the malformation (EA with a distal fistula).
Methods The study comprised 26 children undergoing surgery for EA, who had performed respiratory
and esophageal function studies at the age of 7 years in a follow-up program. The
study design was retrospective analysis of both these 7-year functional investigations
and esophageal and respiratory morbidity from birth to the age of 7 years, as documented
in medical records. Pulmonary function was evaluated mainly by spirometry and multiple
breath washout (MBW), whereas esophageal function was evaluated by 24-hour pH studies.
Results We found a high prevalence of both respiratory (69%) and esophageal (62%) morbidity
between birth and 7 years among the EA children. Examination with MBW (peripheral
airway function) revealed few abnormal results, whereas spirometry revealed high airway
obstruction in half the children, which also correlated well with overall respiratory
symptoms (p = 0.047), as well as recurrent pneumonias (p = 0.035). However, no association with GER symptoms was found. In addition, 46% of
the children had GER according to pH measurements, which were correlated to clinical
GER symptoms but not to respiratory symptoms.
Conclusion This study confirms a high prevalence of respiratory and esophageal morbidity. In
terms of respiratory function, the high proportion with a spirometric abnormality
indicated an associated developmental delay/dysfunction in the central airways, whereas
the peripheral airways appeared to have normal function at this age. Tracheomalacia
may explain the spirometric abnormalities, but this need to be studied in more detail.
Keywords
esophageal atresia - lung function - respiratory morbidity - esophageal morbidity
- gastroesophageal reflux
