title: Physiological Studies at 7 Years of Age in Children Born with Esophageal Atresia.
abstract: OBJECTIVE
  For many years, esophageal atresia (EA) has been curable by surgery. However, severe respiratory morbidity and gastroesophageal reflux (GER) symptoms remain a problem in many patients. The purpose of this study was to describe respiratory and esophageal morbidity, esophageal function, and lung function, including the small airways, in patients with the most common type of the malformation (EA with a distal fistula).
  
  
  METHODS
  The study comprised 26 children undergoing surgery for EA, who had performed respiratory and esophageal function studies at the age of 7 years in a follow-up program. The study design was retrospective analysis of both these 7-year functional investigations and esophageal and respiratory morbidity from birth to the age of 7 years, as documented in medical records. Pulmonary function was evaluated mainly by spirometry and multiple breath washout (MBW), whereas esophageal function was evaluated by 24-hour pH studies.
  
  
  RESULTS
  We found a high prevalence of both respiratory (69%) and esophageal (62%) morbidity between birth and 7 years among the EA children. Examination with MBW (peripheral airway function) revealed few abnormal results, whereas spirometry revealed high airway obstruction in half the children, which also correlated well with overall respiratory symptoms (p = 0.047), as well as recurrent pneumonias (p = 0.035). However, no association with GER symptoms was found. In addition, 46% of the children had GER according to pH measurements, which were correlated to clinical GER symptoms but not to respiratory symptoms.
  
  
  CONCLUSIONS
  This study confirms a high prevalence of respiratory and esophageal morbidity. In terms of respiratory function, the high proportion with a spirometric abnormality indicated an associated developmental delay/dysfunction in the central airways, whereas the peripheral airways appeared to have normal function at this age. Tracheomalacia may explain the spirometric abnormalities, but this need to be studied in more detail.
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Josefin
authors.initials: J
authors.lastname: Olbers
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Vladimir
authors.initials: V
authors.lastname: Gatzinsky
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Linus
authors.initials: L
authors.lastname: Jönsson
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Lars Göran
authors.initials: LG
authors.lastname: Friberg
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Kate
authors.initials: K
authors.lastname: Abrahamsson
authors.affiliation: Department of Pediatric Surgery, The Queen Silvia Children's Hospital, Gothenburg, Sweden.
authors.forename: Ulla
authors.initials: U
authors.lastname: Sillén
authors.affiliation: Department of Pediatrics, Central Hospital, Skövde, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Gustafsson
mesh_terms: D001944:Breath Tests; D002648:Child; D004933:Esophageal Atresia / Q000503:physiopathology* / Q000601:surgery*; D004947:Esophagus / Q000503:physiopathology*; D005080:Exercise Test; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008168:Lung / Q000000981:diagnostic imaging / Q000503:physiopathology*; D008297:Male; D011183:Postoperative Complications; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013147:Spirometry