Cardiorespiratory performance capacity and airway microbiome in patients following primary repair of esophageal atresia

Abstract

BACKGROUND: Patients following repair of an esophageal atresia (EA) or tracheoesophageal fistula (TEF) carry an increased risk of long-term cardiopulmonary malaise. The role of the airway microbiome in EA/TEF patients remains unclear. METHODS: All EA/TEF patients treated between 1980 and 2010 were invited to a prospective clinical examination, spirometry, and spiroergometry. The airway microbiome was determined from deep induced sputum by 16 S rRNA gene sequencing. The results were compared to a healthy age-and sex-matched control group. RESULTS: Nineteen EA/TEF patients with a mean age of 24.7 ± 7 years and 19 age-and sex-matched controls were included. EA/TEF patients showed a significantly lower muscle mass, lower maximum vital capacity (VC max), and higher rates of restrictive ventilation disorders. Spiroergometry revealed a significantly lower relative performance capacity and lower peak VO 2 in EA/TEF patients. Alphaand beta-diversity of the airway microbiome did not differ significantly between the two groups. Linear discriminant effect size analysis revealed significantly enriched species of Prevotella_uncultured, Streptococcus_anginosus, Prevotella_7_Prevotella_enoeca, and Mogibacterium_timidum. CONCLUSION: EA/TEF patients frequently suffer from restrictive ventilation disorders and impaired cardiopulmonary function associated with minor alterations of the airway microbiome. Long-term examinations of EA/TEF patients seem to be necessary in order to detect impaired cardiopulmonary function.

Longitudinal Health Status and Quality of Life After Esophageal Atresia Repair

“…Although EA can be considered a chronic health condition requiring lifelong medical care (36–38), the improved HS from 8 to 12 years that we found might reflect the improvement of children's clinical condition over time. We know from clinical experience that respiratory tract infections, feeding difficulties, and growth failure diminish when these children grow up.…”

Patient-driven healthcare recommendations for adults with esophageal atresia and their families

“…A standardized follow-up program -which was not yet available during the childhood of these older patients -will allow intervention at an early stage. Adults with EA suffer from impaired performance capacity as well [29] . Still, pulmonary rehabilitation may improve exercise tolerance [30] .…”

Habitual physical activity in patients born with oesophageal atresia: a multicenter cross-sectional study and comparison to a healthy reference cohort matched for gender and age

“…Most patients complained of dyspnea linked to tracheomalacia during exertion. For adolescents with EA, a significantly lower vital capacity and a high prevalence of restrictive ventilatory disorders have been described [ 12 , 27 ], which might be rooted in recurrent pulmonary infections in early childhood [ 3 ]. Surprisingly, even respiratory symptoms during PA were not associated with a statistically significant decrease of sports index or MVPA minutes in our cohort.…”

“…In these cases, it is recommended to set individual sustainable goals [ 9 ]. In patients born with EA, delayed development of motor skills [ 4 , 11 ] and impaired exercise capacity [ 12 , 13 ] have been described. Furthermore, longer cumulative anaesthesia duration was associated with gross motor problems [ 7 ].…”