RESUMO
We have studied for periods averaging 111 months 16 survivors out of a series of 20 children treated for oesophageal atresia (EA) by neonatal end-to-end anastomosis. Twelve of them had gastroesophageal reflux (GER) manifested by either digestive (vomiting, dysphagia, pyrosis, haemorrhage or foreign body impaction) or respiratory symptoms (repeated neumoniae or frequent u.r.i.). pH-studies decealed very increased acid exposure in these patients. Manometric studies showed disorganized peristalsis with near-absence of propulsive waves and predominance of mass-contractions. Interestingly both lower esophageal sphincter pressure and length were normal. Five children had histological esophagitis and 2 had Barrett's esophagus. Seven patients have had an anti-reflux procedure and two more should be operated in the near future. Our experience reveals that GER incidence in EA is very high, that esophageal function is severely impaired in this condition, that mucosal lesions can be serious and that funduplication is effective. Since it has been demonstrated that esophageal dysfunction in EA patients is due to structural anomalies, spontaneous improvement should not be expected in them and surgical treatment should be largely indicated. EA patients require long-term gastro-enterologic follow-up.
