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1.
Eur Respir J ; 36(5): 1106-12, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20351029

ABSTRACT

Although after oesophageal atresia (OA) repair in infancy, respiratory problems are common, their natural history remains unclear. We assessed morbidity, pulmonary function (PF), and bronchial hyperresponsiveness (BHR) in adults with repaired OA respiratory. 588 patients who underwent surgery for OA during 1947-1985 were identified and those 262 who were alive and had their native oesophagus were included. Respiratory symptoms and respiratory symptom-related quality of life (RSRQoL) were assessed by questionnaire and interview, and the patients underwent spirometry, a histamine challenge test, and an exhaled nitric oxide test. For the questionnaires, we added 287 carefully matched general population-derived controls. Among the 101 (58 male) patients, median age 36 yrs (range 22-56 yrs), respiratory morbidity was significantly increased compared to controls. Patients had more respiratory symptoms and infections, as well as asthma and allergies, and more often impaired RSRQoL (p<0.001 for all). PF tests revealed restrictive ventilatory defect in 21 (21%) patients, obstructive ventilatory defect in 21 (21%) patients, and both in 36 (36%) patients. A total of 41 (41%) had BHR, and in 15 (15%), it was consistent with asthma. The most significant risk factors for restrictive ventilatory defect were thoracotomy-induced rib fusions (OR 3.4, 95% CI 1.3-8.7; p = 0.01) and oesophageal epithelial metaplasia (OR 3.0, 95% CI 1.0-8.9; p = 0.05). After repair of OA, respiratory-related morbidity, restrictive ventilatory defect and BHR extended into adulthood. Nearly half the patients had BHR and over half had a restrictive ventilatory defect. Thoracotomy-induced rib fusions and gastro-oesophageal reflux-associated oesophageal epithelial metaplasia were the strongest risk factors for restrictive ventilatory defect.


Subject(s)
Bronchial Hyperreactivity/epidemiology , Esophageal Atresia , Tracheoesophageal Fistula , Adult , Asthma/epidemiology , Bronchitis/epidemiology , Esophageal Atresia/epidemiology , Esophageal Atresia/pathology , Esophageal Atresia/surgery , Female , Humans , Hypersensitivity/epidemiology , Infant , Male , Middle Aged , Morbidity , Pneumonia/epidemiology , Predictive Value of Tests , Quality of Life , Risk Factors , Spirometry , Surveys and Questionnaires , Tracheoesophageal Fistula/epidemiology , Tracheoesophageal Fistula/pathology , Tracheoesophageal Fistula/surgery , Young Adult
2.
Semin Pediatr Surg ; 18(1): 50-6, 2009 Feb.
Article in English | MEDLINE | ID: mdl-19103423

ABSTRACT

Survivors of esophageal atresia are reaching their adulthood in large numbers for the first time enabling assessment of true long-term outcome among this group of patients. This review summarizes the current knowledge on the subject focusing on late symptoms and complications, esophageal pathology and pulmonary function. Relationships between esophageal dysmotility, gastroesophageal reflux, esophagitis and epithelial metaplastic changes including esophageal cancer are outlined. In addition to pertinent literature, institutional experience, and follow-up of patients with esophageal atresia for more than 60 years is included.


Subject(s)
Esophageal Atresia/complications , Esophageal Atresia/surgery , Esophagus/surgery , Thoracotomy/adverse effects , Adult , Age Factors , Anastomosis, Surgical/adverse effects , Humans , Survival Analysis , Time Factors , Treatment Outcome
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