title: Defective upper gastrointestinal function after repair of combined esophageal and duodenal atresia.
abstract: BACKGROUND
  Both esophageal atresia (EA) and duodenal atresia (DA) involve deficient anti-reflux barrier, poor esophageal function and eventually, duodenogastric reflux. This study aims at examining the upper gastrointestinal functional status in a cohort of patients with both EA and DA.
  
  
  METHODS
  A retrospective survey of patients treated for EA and DA between 1965 and 2012 was conducted. Clinical charts, office visits, imaging, upper gastrointestinal endoscopy and esophageal pH metry/impedance were used to assess the long-term condition of the esophagus, the presence of gastroesophageal reflux disease (GERD) and/or the need for fundoplication.
  
  
  RESULTS
  Twenty out of 581 patients treated for EA had associated DA. Ten/twenty children survived; 1 had primary esophageal replacement. With a median follow-up of 9 years, 8/9 had complicated outcomes and 5 still suffered digestive ailments: 2 GER; 1 eosinophilic esophagitis; 1 nodular gastritis, and 1 wrap herniation. A total of 10 procedures were performed: 8 fundoplications, 1 esophagogastric dissociation and 1 replacement with colon.
  
  
  CONCLUSIONS
  The association of EA with DA involves a poor upper digestive function with high risks of GERD and fundoplication failure. The lifelong synergistic play of esophageal, gastric and duodenal dysfunctions in these patients prompts long-term follow-up, and eventually active treatment.
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; INGEMM and Idipaz Research Laboratory, Department of Pediatrics, Universidad Autonoma de Madrid; Faculty of Medicine, University of Porto. Porto, Portugal. Electronic address: catarina.fragoso@gmail.com.
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Fragoso
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Ruben
authors.initials: R
authors.lastname: Ortiz
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Hernandez
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Olivares
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; INGEMM and Idipaz Research Laboratory, Department of Pediatrics, Universidad Autonoma de Madrid.
authors.forename: Leopoldo
authors.initials: L
authors.lastname: Martinez
authors.affiliation: Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain; INGEMM and Idipaz Research Laboratory, Department of Pediatrics, Universidad Autonoma de Madrid.
authors.forename: Juan A
authors.initials: JA
authors.lastname: Tovar
mesh_terms: D003679:Deglutition / Q000502:physiology*; D004380:Duodenal Obstruction / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004933:Esophageal Atresia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D004943:Esophagogastric Junction / Q000503:physiopathology*; D005260:Female; D018662:Fundoplication / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000503:physiopathology*; D006801:Humans; D007231:Infant, Newborn; D007409:Intestinal Atresia; D008297:Male; D012189:Retrospective Studies
keywords: Complications; Duodenal atresia; Esophageal; Esophageal atresia; Fundoplication; Gastric and duodenal dysfunction; Gastroesophageal reflux; Outcome