Patterns of gastroesophageal reflux in children following repair of esophageal atresia and distal tracheoesophageal fistula

Abstract Purpose The purpose of this study is to conduct a retrospective chart review of patients with a rare congenital deformity, tracheoesophageal fistula, and esophageal atresia treated at a small, freestanding Children's Hospital. The goal is to identify important variables to inform clinical pathways and prospective database creation. Current national surgical quality databases do not track tracheoesophageal fistula/esophageal atresia (TEF/EA)-specific data points such as TEF-type and incidence of postoperative complications such as gastroesophageal reflux disease (GERD) and esophageal stricture. Methods Patients diagnosed with esophageal atresia and trachesophageal fistula between January 2005 and January 2019 were identified using the appropriate ICD 9 or ICD 10 codes. Data for 35 variables including patient demographics and type of esophageal atresia were abstracted. SPSS 16.0 software was used for descriptive statistics. Results A total of 43 patients were identified, 64.3% female and 35.7% male. 77.5% were type C, 12.5% type A, 7.5% type H, and 2.5% type D. 15% were long-gap type. 53.8% had postoperative esophageal strictures, and 66.7% had postoperative gastroesophageal reflux disease. Of those who had strictures, 77.2% of patients required at least three postoperative dilations for stricture, with an overall mean six dilations. 26.2% of patients had tracheomalacia; of these, two patients underwent thoracoscopic aortopexy. Four patients were not included in subgroup analysis: two patients had missing variables, one patient passed away before surgical intervention, and one patient has not yet undergone surgical intervention for EA/TEF. Conclusions We conclude that, although a rare congenital anomaly, a database dedicated to tracheoesophageal fistula and esophageal atresia at a pediatric hospital can aid in reviewing trends in outcomes and inform standardization of management.

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Prevalence of acid gastroesophageal reflux disease in infants with esophageal atresia/tracheoesophageal fistula

Pediatric Research ◽

10.1038/s41390-021-01510-w ◽

2021 ◽

Author(s):

Charlotte Flatrès ◽

Madeleine Aumar ◽

Delphine Ley ◽

Rony Sfeir ◽

Audrey Nicolas ◽

...

Keyword(s):

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Esophageal Atresia ◽

Reflux Disease ◽

Tracheoesophageal Fistula

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H-Type Tracheoesophageal Fistula Masquerading as Grade V Gastroesophageal Reflux in a Neonate

Journal of Neonatology ◽

10.1177/09732179211040614 ◽

2021 ◽

pp. 097321792110406

Author(s):

Nasreen Banu ◽

VVS Chandrasekharam ◽

Durga Prasad Koduru

Keyword(s):

Congenital Anomaly ◽

Early Diagnosis ◽

Gastroesophageal Reflux ◽

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

Neonatal Period ◽

Postoperative Outcome ◽

Clinical Suspicion ◽

Rare Congenital Anomaly ◽

Cervical Approach

Tracheoesophageal fistula (TEF) without associated esophageal atresia is a rare congenital anomaly. Diagnosis in neonatal period is usually not made and most of the patients are treated as cases of pneumonia. We report a case of H-type TEF, which was initially diagnosed as grade V gastroesophageal reflux on contrast esophagogram and bronchoscopy done revealed H-type fistula. Through cervical approach, fistula was repaired and baby had uneventful postoperative outcome. High index of clinical suspicion and early diagnosis can provide a better prognosis.

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Incidence and significance of gastroesophageal reflux following repair of esophageal atresia and tracheoesophageal fistula and the need for anti-reflux procedures

Journal of Pediatric Surgery ◽

10.1016/s0022-3468(79)80568-0 ◽

1979 ◽

Vol 14 (1) ◽

pp. 5-8 ◽

Cited By ~ 79

Author(s):

A. Frederick Parker ◽

Dennis L. Christie ◽

John L. Cahill

Keyword(s):

Gastroesophageal Reflux ◽

Esophageal Atresia ◽

Tracheoesophageal Fistula

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DOZ047.109: Impact of positive expiratory pressure breathing on gastroesophageal reflux: preliminary report in children with esophageal atresia and tracheoesophageal fistula and residual tracheomalacia

Diseases of the Esophagus ◽

10.1093/dote/doz047.109 ◽

2019 ◽

Vol 32 (Supplement_1) ◽

Author(s):

F Porcaro ◽

R Tambucci ◽

F Petreschi ◽

P Leone ◽

M Malamisura ◽

...

Keyword(s):

Gastroesophageal Reflux ◽

Esophageal Atresia ◽

Tracheoesophageal Fistula ◽

Ph Monitoring ◽

Chest Physiotherapy ◽

Fasting Period ◽

Preliminary Results ◽

Acid Suppression Therapy ◽

The Impact ◽

Positive Expiratory Pressure

Abstract Introduction The usefulness of positive expiratory pressure (PEP) through a PEP valve to enhance expiratory flow and improve cough efficiency is well known in children with tracheoesophageal fistula (TEF) and residual tracheomalacia. Gastroesophageal reflux (GER) is one of the most frequent complications encountered in patients with repaired esophageal atresia (EA) ± TEF. The impact of airway clearance techniques with a PEP valve on GER is not well defined in this group of patients. The aim of this prospective study was to determine the effects of PEP chest physiotherapy on GER burden measured by multichannel intraluminal impedance and pH monitoring (MII-pH) in EA/TEF children. Since the study is still ongoing, preliminary results are hereby presented. Methods EA/TEF patients with tracheomalacia received three 20-min sessions of PEP chest therapy during the 24-hour MII-pH monitoring performed as a routine care. All children were off acid suppression therapy. The PEP session, performed after a 3-hour fasting period, consisted of 10 cycles lasting 1 minute of breathing with a PEP valve, followed by the forced expiratory technique and coughing. Esophageal acid exposure time (AET) and number of reflux episodes (RE) during each PEP session were measured as primary outcomes. Baseline impedance (BI) was also evaluated. MII-pH was defined abnormal if AET was >7% and/or the total RE was >70. Results From January and December 2018, 5 consecutive male EA/TEF children (mean age 8.5 years; range 3–14 years) were enrolled. All of them showed low distal BI (1040 ± 143.2) and normal MII-pH findings (AET: 1.8 ± 2.9%; number of RE: 20.2 ± 9.0). Over the period of the PEP sessions, no significant changes in AET (0.0 ± 0.0), RE (0.6 ± 0.5), and BI were detected compared with the background monitoring. Conclusions Although the limited number of participants prevents any definitive conclusions, our preliminary results indicate that PEP chest physiotherapy does not exacerbate GER in EA/TEF children. Continuation of the study across a larger sample of EA/TEF patients is needed to better define the effects of this simple chest physiotherapy technique on GER burden.

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