Gastroesophageal reflux and Barrett's esophagus in adults born with esophageal atresia.
OBJECTIVE
Postoperative morbidity after correction of esophageal atresia is partly determined by gastroesophageal reflux disease, which has been proven to affect from one-half to two-thirds of patients during childhood. We conducted a follow-up study to test our hypothesis that, if former patients still show gastroesophageal reflux at adult age, they are at high risk for developing Barrett's esophagus, which is considered to be premalignant.


METHODS
Of 69 patients born between 1971 and 1978, all having undergone a primary anastomosis, 24 had died, five of them because of aspiration. Of the 45 survivors, 39 could be traced; they all completed a questionnaire inquiring after symptoms related to the esophagus. Of these patients, 34 underwent an additional esophagogastrocopy.


RESULTS
Only nine of the 39 patients had no symptoms at all; 30 had mild to severe dysphagia symptoms, and 13 had mild to severe reflux symptoms. Esophagogastrocopy in 34 patients revealed that the anastomosis was still recognizable in all cases, but stenoses were not found. Six patients showed a small hiatal hernia, and one a large one. The incidences of reflux symptoms (13/39, p < 0.01), reflux esophagitis (9/34, p < 0.01) and Barrett's esophagus (2/34, p < 0.001) were significantly higher than in the normal population.


CONCLUSIONS
This group seems to be at risk for developing Barrett's esophagus. As this is the first follow-up study of a consecutive group of adult esophageal atresia patients, we think it is advisable to perform an esophagogastroscopy in all patients at adulthood until more long term follow-up data are available.
Krug
E
E
Department of Pediatric Surgery, Sophia Children's Hospital, Rotterdam, The Netherlands.
Bergmeijer
J H
JH
Dees
J
J
de Krijger
R
R
Mooi
W J
WJ
Hazebroek
F W
FW
D000293:Adolescent; D000328:Adult; D001471:Barrett Esophagus / Q000175:diagnosis / Q000209:etiology*; D004933:Esophageal Atresia / Q000150:complications* / Q000601:surgery; D004942:Esophagitis, Peptic / Q000175:diagnosis; D004945:Esophagoscopy; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000209:etiology*; D005773:Gastroscopy; D006801:Humans; D008297:Male; D012307:Risk Factors