Swallowing Dysfunction and Quality of Life in Adults With Surgically Corrected Esophageal Atresia/Tracheoesophageal Fistula as Infants: Forty Years of Follow-up.

OBJECTIVES: The aim of the study was to evaluate and study the full spectrum of swallowing dysfunction and long-term disease-specific outcomes in adults with surgically corrected esophageal atresia/tracheaesophageal fistula (EA/TEF). BACKGROUND: Long-term outcomes for adults who underwent EA/TEF repair because infants are lacking. METHODS: We developed a disease-specific swallowing dysfunction questionnaire (SDQ) to assess swallowing dysfunction and quality of life (QOL) of adult patients with surgically corrected EA/TEF. Patients were surveyed with the newly developed SDQ and with a generic QOL tool (36-Item Short Form Health Survey). RESULTS: Ninety-seven patients underwent EA/TEF repair at our institution from 1950 to 1997. Forty-six (61%) patients completed the survey. Median follow-up was 40 years (range 18-63). Results suggest that some degree of swallowing dysfunction is common (82%), worse with hard consistencies (70%), and is associated with frequently needing sips of liquids to facilitate swallowing (75%). The presence of swallowing dysfunction was, however, often mild and did not seem to affect patients' food choices, or their day-to-day activities. QOL did not differ from that of the general population, regardless of the presence or absence of swallowing dysfunction. The presence of gastroesophageal reflux disease (26%), esophageal stricture (39%), or both (15%) does not account for all situations of swallowing dysfunction, nor does it significantly impact QOL. CONCLUSIONS: Swallowing dysfunction is common in adults who underwent EA/TEF repair as infants; however, patients reported minimal effect on QOL or day-to-day activities. The SDQ is a valid and reliable tool to measure the full spectrum of swallowing dysfunction in the EA/TEF repair population.

Long-Term Outcome of IPAA in Patients Presenting with Fulminant Ulcerative Colitis: A Matched Cohort Study.

BACKGROUND: Studies reveal that ileal pouch-anal anastomosis (IPAA) has long-term success. These reports, however, use well-selected cohorts and exclude patients presenting with fulminant colitis (FC). Herein, we aimed to characterize long-term functional outcomes in patients with fulminant ulcerative colitis (UC) undergoing IPAA. METHODS: A prospective database identified patients who underwent IPAA between 1998 and 2008. Patients with FC and chronic UC were matched by age, gender, date of surgery, and follow-up duration. Clinical and laboratory parameters, immunomodulator use at the time of surgery, and functional outcomes were compared. RESULTS: Forty patients with FC and 73 patients with chronic UC were identified. Preoperative albumin, hemoglobin, leukocyte count, and steroid dose were significantly different for those with FC. Average survey follow-up was 5.2 years for FC and 6.7 years for chronic UC patients. Functional outcomes were not significantly different. The 3-year fistula-free rate was 91.4 versus 98.6 % and the 3-year stricture-free rate was 79.3 versus 87.2 % for FC versus chronic UC patients, respectively. CONCLUSION: Patients undergoing colectomy for FC secondary to UC have similar long-term functional outcomes after IPAA despite significantly worse presentation. This study confirms that IPAA is an appropriate and durable treatment for patients with FC.