Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia

Abstract

Chronic, long-term respiratory morbidity (CRM) is common in patients with a history of repaired congenital esophageal atresia, typically associated with tracheoesophageal fistula (EA/TEF). EA/TEF patients are at high risk of having aspiration, and retrospective studies have associated CRM with both recurrent aspiration and atopy. However, studies evaluating the association between CRM in this population and either aspiration or atopy have reported conflicting results. Furthermore, CRM in this population may be due to other related conditions as well, such as tracheomalacia and/or recurrent infections. Aspiration is difficult to confirm, short of lung biopsy. Moreover, even within the largest evidence base assessing the association between CRM and aspiration, which has evaluated the potential relationship between gastroesophageal reflux and asthma, findings are contradictory. Studies attempting to relate CRM to prior aspiration events may inadequately estimate the frequency and severity of previous aspiration episodes. There is convincing evidence documenting that chronic, massive aspiration in patients with repaired EA/TEF is associated with the development of bronchiectasis. While chronic aspiration is likely associated with other CRM in patients with repaired EA/TEF, this does not appear to have been confirmed by the data currently available. Prospective studies that systematically evaluate aspiration risk and allergic disease in patients with repaired EA/TEF and document subsequent CRM will be needed to clarify the causes of CRM in this population. Given the prevalence of CRM, patients with repaired EA/TEF should ideally receive regular follow-up by multidisciplinary teams with expertise in this condition, throughout both childhood and adulthood.

Pepsin as a Marker of Reflux Aspiration in Children With Esophageal Atresia: A Pilot Study

“…However, salivary pepsin did not correlate with other respiratory symptoms, pulmonary function testing results or LRSQ scores. Although this could be due to the small sample size of the current study, a more likely explanation may be the multi-factorial etiology for respiratory morbidity in EA patients with reflux aspiration being only one of the causes (2).…”

“…Esophageal atresia associated with tracheo-esophageal fistula (EA), is commonly associated with long-term gastrointestinal and respiratory morbidity including gastroesophageal reflux disease (GERD), esophageal strictures, recurrent respiratory tract infections, chronic cough and asthma (1). GERD resulting in reflux aspiration is one of the causes for respiratory complications in this cohort (2). GERD occurs in 22-45% of EA patients (3).…”

“…Timely detection and management of reflux aspiration is essential to prevent long-term respiratory morbidity in EA patients (2). However, the diagnosis of micro-aspiration of gastric fluid remains challenging.…”

Oral aspiration, type 1 laryngeal cleft, and respiratory tract infections in canadian inuit children

“…In this study, we did not investigate interrelationships between oral aspiration and gastroesophageal reflux, although both conditions may predispose children to LRTI, and both conditions may occur concurrently. 21 However, recent research has suggested that use of proton pump inhibitors in children with aspiration may increase the risk of all-cause hospitalization. 22 We did not track concurrent medication use.…”

Osteopathic Manipulative Treatment in a Paediatric Patient with Oesophageal Atresia and Tracheo-Oesophageal Fistula

“…Feeding problems, which occur in 79% of infants [12], increase the risk of airway aspiration and might be responsible for chronic respiratory morbidity, such as recurrent pneumonia, asthma, and bronchiolitis [13].…”