title: Esophageal morbidity and function in adults with repaired esophageal atresia with tracheoesophageal fistula: a population-based long-term follow-up.
abstract: OBJECTIVE
  We assessed esophageal morbidity and relationships between surgical complications, symptoms, endoscopic findings, immunohistochemistry, and esophageal motility in adults with repaired esophageal atresia (EA).
  
  
  BACKGROUND
  There exist no previous population-based long-term follow-up studies on EA.
  
  
  METHODS
  Participants were interviewed, and they underwent esophageal endoscopy and manometry. Matched control subjects (n = 287) served as controls.
  
  
  RESULTS
  A total of 101 (42%) individuals representative of the entire study population participated at a mean age of 36 years (range, 21-57). Symptomatic gastroesophageal reflux had occurred in 34% and dysphagia in 85% of the patients and in 8% and 2% of the controls (P < 0.001 for both). Endoscopic findings included hiatal hernia (28%), Barrett's esophagus (11%), esophagitis (8%), and anastomotic stricture (8%). Immunohistochemistry revealed esophagitis in 25%, and CDX2-positive columnar epithelial metaplasia in 21%, with additional goblet cells and MUC2 positivity in 6%. Gastroesophageal reflux and dysphagia were equally common in individuals with normal histology, esophagitis, or epithelial metaplasia. Manometry demonstrated nonpropagating peristalsis in 80% of the patients, and low distal wave amplitudes of the esophagus in all the changes being significantly worse in those with epithelial metaplasia (P < or = 0.022 metaplasia vs. esophagitis/normal). Anastomotic complications (odds ratio [OR]: 8.6-24, 95% confidence interval [CI]: 1.7-260, P = 0.011-0.008), age (OR: 20, 95% CI: 1.3-310, P = 0.034), low distal esophageal body pressure (OR: 2.6, 95% CI: 0.7-10, P = 0.002), and defective esophageal peristalsis (OR: 2.2, 95% CI: 0.4-11, P = 0.014) predicted development of epithelial metaplasia.
  
  
  CONCLUSIONS
  Significant esophageal morbidity associated with EA extends into adulthood. Surgical complications, increasing age, and impaired esophageal motility predict development of epithelial metaplasia after repair of EA.
authors.affiliation: Section of Pediatric Surgery, Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland. saara.sistonen@helsinki.fi
authors.forename: Saara J
authors.initials: SJ
authors.lastname: Sistonen
authors.forename: Antti
authors.initials: A
authors.lastname: Koivusalo
authors.forename: Urpo
authors.initials: U
authors.lastname: Nieminen
authors.forename: Harry
authors.initials: H
authors.lastname: Lindahl
authors.forename: Jouko
authors.initials: J
authors.lastname: Lohi
authors.forename: Mia
authors.initials: M
authors.lastname: Kero
authors.forename: Päivi A
authors.initials: PA
authors.lastname: Kärkkäinen
authors.forename: Martti A
authors.initials: MA
authors.lastname: Färkkilä
authors.forename: Seppo
authors.initials: S
authors.lastname: Sarna
authors.forename: Risto J
authors.initials: RJ
authors.lastname: Rintala
authors.forename: Mikko P
authors.initials: MP
authors.lastname: Pakarinen
mesh_terms: D000328:Adult; D001471:Barrett Esophagus / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D016099:Endoscopy, Gastrointestinal; D004933:Esophageal Atresia / Q000150:complications / Q000601:surgery*; D004935:Esophageal Diseases / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology; D004941:Esophagitis / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D004947:Esophagus / Q000473:pathology / Q000503:physiopathology*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D006801:Humans; D008297:Male; D008365:Manometry; D008875:Middle Aged; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000601:surgery*