Gastroesophageal reflux: prevalence in adults older than 28 years after correction of esophageal atresia.

OBJECTIVE: To study the incidence of gastroesophageal reflux (GER)related complications after correction of esophageal atresia (EA). SUMMARY BACKGROUND DATA: The association of EA and GER in children is well known. However, little is known about the prevalence of GER and its potential complications in adults who have undergone correction of EA as a child. METHODS: Prospective analysis of the prevalence of GER and its complications over 28 years after correction of EA by means of a questionnaire, esophagogastroscopy, and histologic evaluation of esophageal biopsies. RESULTS: The questionnaire was returned by 38 (95%) of 40 patients. A quarter of the patients had no complaints. Swallowing solid food was a problem for 13 patients (34%), and mashed foods for 2 (5%). Heartburn was experienced by 7 patients (18%), retrosternal pain by 8 (21%). However, none of the patients were using antireflux medication. Twenty-three patients (61%) agreed to undergo esophagogastroscopy, which showed macroscopic Barrett esophagus in 1 patient, which was confirmed by histology. One patient developed complaints of dysphagia at the end of the study. A squamous cell esophageal carcinoma was diagnosed and treated by transthoracic subtotal esophagectomy. CONCLUSIONS: This study shows a high incidence of GER-related complications after correction of EA, but it is still very disputable if all EA patients should be screened at an adult age.

Esophageal atresia: historical evolution of management and results in 371 patients.

BACKGROUND: It has been more than 50 years since the first successful surgical reconstruction of esophageal atresia was performed in The Netherlands. We reviewed the historical changes in management and treatment results of patients born with esophageal atresia. METHODS: We developed and analyzed a database of 371 consecutive patients treated for esophageal atresia in our center between 1947 and 2000. RESULTS: The mean birthweight decreased from 2,723 g (1947 to 1968) to 2,494 g (1994 to 2000), the mean gestational age decreased from 39 weeks (1947 to 1968) to 37 weeks (1994 to 2000). The number of patients with associated congenital malformations increased from 34% (1947 to 1968) to 66% (1994 to 2000). Most patients underwent primary repair of their atresia. Clinically significant tracheomalacia was present in 34 of 269 patients (13%). Gastroesophageal reflux was present in 90 of 277 patients (33%). Mortality decreased from 61% (1947 to 1968) to 11% (1994 to 2000). CONCLUSIONS: The patients who are treated nowadays for esophageal atresia in a pediatric surgical center are born earlier, weigh less, and have more associated anomalies than those treated 50 years ago. Still, the mortality rate is much lower thanks to earlier diagnosis, better supportive care and improved surgical techniques. Therefore, further significant reduction will be difficult to achieve.