title: Intestinal Metaplasia of the Esophagus in Children With Esophageal Atresia.
abstract: Patients with esophageal atresia/tracheoesophageal fistula (EA-TEF) can develop Barrett esophagus as a long-term consequence of their condition. Intestinal metaplasia (IM), a risk factor for developing adenocarcinoma of the esophagus, has not been well characterized in the pediatric population.
  
  
  
  Retrospective review of patients with EA-TEF followed at 3 academic pediatric centers between the years 1997 and 2014.
  
  
  
  Among 542 children and adolescents, 1.3% (7 patients, 5 girls) were diagnosed with IM based on endoscopy and pathology. Six of the patients had EA-TEF type C, whereas the last patient had a "long gap" type A atresia. Patients were diagnosed with gastric metaplasia either before the IM diagnosis in 4 patients or concomitantly in 3. The median (range) age of diagnosis for gastric metaplasia was 7.9 (range 2-17.2) and for IM 10.9 (2-17.2) years. Gastroesophageal reflux (GER) symptoms were nonspecific. Five patients were on proton pump inhibitor therapy for symptomatic GER at the time of diagnosis of IM. 2 of the 7 patients had previously undergone Nissen fundoplication. One patient, who had undergone a Nissen fundoplication, was restarted on proton pump inhibitor once the diagnosis of IM was made. All patients had repeated endoscopy and dysplasia was not observed with a median follow-up of 1.7 (range 1-4.9) years.
  
  
  
  IM occurs in patients with EA-TEF, some as young as 2 years. Therefore, early endoscopic surveillance should be considered in this GER-prone population.
authors.affiliation: *Esophageal Atresia Clinic Sainte-Justine University Health Centre, Université de Montréal, Montreal, Canada†Reference Centre for Congenital and Malformative Esophageal Diseases, CHU Lille, University Lille2, Lille, France‡Sydney Children's Hospital, Sydney, NSW, Australia§Department of Pathology, Sainte-Justine University Health Centre, Université de Montréal, Montreal, Canada.
authors.forename: Helen
authors.initials: H
authors.lastname: Hsieh
authors.forename: Adam
authors.initials: A
authors.lastname: Frenette
authors.forename: Laurent
authors.initials: L
authors.lastname: Michaud
authors.forename: Usha
authors.initials: U
authors.lastname: Krishnan
authors.forename: Dorothée B
authors.initials: DB
authors.lastname: Dal-Soglio
authors.forename: Frederic
authors.initials: F
authors.lastname: Gottrand
authors.forename: Christophe
authors.initials: C
authors.lastname: Faure
mesh_terms: D000293:Adolescent; D000359:Aftercare; D001471:Barrett Esophagus / Q000209:etiology / Q000473:pathology; D002648:Child; D002675:Child, Preschool; D004933:Esophageal Atresia / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery; D004945:Esophagoscopy; D004947:Esophagus / Q000000981:diagnostic imaging / Q000473:pathology*; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000473:pathology; D006801:Humans; D007422:Intestines; D008297:Male; D008679:Metaplasia; D012189:Retrospective Studies; D014138:Tracheoesophageal Fistula / Q000000981:diagnostic imaging / Q000473:pathology* / Q000601:surgery