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J Pediatr Surg. 2017 Aug;52(8):1255-1259. doi: 10.1016/j.jpedsurg.2016.12.025. Epub 2017 Jan 3.

Pulmonary outcome of esophageal atresia patients and its potential causes in early childhood.

Author information

1
Charité Universitaetsmedizin Berlin, Department of Pediatric Surgery, Augustenburger Platz 1, 13353 Berlin. Electronic address: rene-dittrich@t-online.de.
2
Charité Universitaetsmedizin Berlin, Department of Pediatric Pulmonology and Immunology, Augustenburger Platz 1, 13353 Berlin; Altonaer Kinderkrankenhaus, Bleickenallee 38, 22763 Hamburg.
3
Charité Universitaetsmedizin Berlin, Department of Pediatric Surgery, Augustenburger Platz 1, 13353 Berlin.
4
Charité Universitaetsmedizin Berlin, Department of Pediatric Surgery, Augustenburger Platz 1, 13353 Berlin; Klinikum Ernst von Bergmann, Department of Pediatric Surgery, Charlottenstrasse 72, 14467 Potsdam.

Abstract

INTRODUCTION:

The aim of this study was to illustrate the pulmonary long term outcome of patients with repaired esophageal atresia and to further examine causes and correlations that might have led to this outcome.

METHODS:

Twenty-seven of 62 possible patients (43%) aged 5-20years, with repaired esophageal atresia were recruited. Body plethysmography and spirometry were performed to evaluate lung function, and the Bruce protocol treadmill exercise test to assess physical fitness. Results were correlated to conditions such as interpouch distance, gastroesophageal reflux or duration of post-operative mechanical ventilation.

RESULTS:

Seventeen participants (63%) showed abnormal lung function at rest or after exercise. Restrictive ventilatory defects (solely restrictive or combined) were found in 11 participants (41%), and obstructive ventilatory defects (solely obstructive or combined) in 13 subjects (48%). Twenty-two participants (81%) performed the Bruce protocol treadmill exercise test to standard. The treadmill exercise results were expressed in z-score and revealed to be significantly below the standard population mean (z-score=-1.40). Moreover, significant correlations between restrictive ventilatory defects and the interpouch distance; duration of post-operative ventilation; gastroesophageal reflux disease; plus recurrent aspiration pneumonia during infancy; were described.

CONCLUSION:

It was shown that esophageal atresia and associated early complications have significant impact on pulmonary long term outcomes such as abnormal lung function and, in particular restrictive ventilatory defects. Long-running and regular follow-ups of patients with congenital esophageal atresia are necessary in order to detect and react to the development and progression of associated complications such as ventilation disorders or gastroesophageal reflux disease.

LEVEL OF EVIDENCE:

Prognosis study, Level II.

KEYWORDS:

Bruce protocol; Complication; Esophageal atresia; Gastroesophageal reflux; Lung function; Pulmonary outcome

PMID:
28094013
DOI:
10.1016/j.jpedsurg.2016.12.025
[Indexed for MEDLINE]

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