Original article
Gastroesophageal Reflux and Related Pathology in Adults Who Were Born With Esophageal Atresia: A Long-Term Follow-up Study

https://doi.org/10.1016/j.cgh.2007.03.012Get rights and content

Background & Aims: Esophageal atresia (EA) is the most common congenital anomaly of the esophagus. There are few long-term follow-up data on adults who had surgery for EA as infants. The primary aims were to evaluate the prevalence of esophageal symptoms and pathology and second to develop recommendations for follow-up. Methods: This is a descriptive study of individuals attending a clinic in an adult tertiary referral hospital, established to provide care for adults who had surgery for EA as infants. Individuals aged 20 years or older were identified from an existing database and invited by telephone to attend the clinic. One hundred thirty-two patients attended the clinic from 2000–2003. Individuals were assessed by using a structured questionnaire. Endoscopy was performed in 62 patients because of symptoms. Results: Reflux symptoms were reported by 83 (63%), including 25 (19%) with severe symptoms. Dysphagia was reported by 68 patients (52%). Of those who underwent endoscopy, reflux esophagitis was present in 36 patients (58%), Barrett’s esophagus in 7 (11%), and strictures in 26 (42%) patients. One patient was diagnosed with esophageal squamous cell carcinoma. Men who were 35 years or older and individuals with severe reflux symptoms were at high risk of having severe esophagitis or Barrett’s metaplasia. Conclusions: Reflux symptoms, esophagitis, and Barrett’s esophagus are common in these individuals. We recommend clinical assessment as adults and upper endoscopy for reflux symptoms or dysphagia. Transition of young adults from pediatric care to an adult gastroenterology clinic with expertise in EA appears to be highly beneficial.

Section snippets

Methods

The Oesophageal Atresia Review Clinic for Adults was established in March 2000 as a joint clinic of Royal Children’s Hospital and St Vincent’s Hospital Melbourne, Australia with the primary aim of providing expert assessment and care for this group of patients. The clinic was attended by gastroenterologists and pediatric surgeons to provide continuity and expertise. Attempts were made to trace and contact all adults aged at least 20 years who were identified from a database of patients who had

Results

Four hundred eighty-five infants had undergone surgery for EA at Royal Children’s Hospital up to 1982. Of these individuals, 316 were believed to be alive on the basis of a previous follow-up study in 1988.6 Among this group, 10 deaths had occurred since 1988, and 18 others could not be contacted. Two hundred eighty-eight were able to be contacted and were invited to attend the clinic. One hundred thirty-two patients (46%) attended the clinic from 2000–2003. Characteristics of these patients

Discussion

This series is easily the largest long-term follow-up study after surgery for EA. There are several important issues arising from these data that have direct implications for the management of these patients as well as some areas for further research and clarification.

These data show that ongoing esophageal symptoms are common, whereas respiratory problems are less frequent but still significant. Despite the frequency of these symptoms, it is striking that most adults born with EA have grown

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Supported by the Oesophageal Atresia Research Auxiliary of the Royal Children’s Hospital Melbourne.

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