Dysphagia among Adult Patients who Underwent Surgery for Esophageal Atresia at Birth

Abstract

BACKGROUND: Clinical experiences of adults who underwent surgery for esophageal atresia at birth is limited. There is some evidence that suggests considerable long-term morbidity, partly because of dysphagia, which has been reported in up to 85% of adult patients who undergo surgery for esophageal atresia. The authors hypothesized that dysphagia in this population is caused by dysmotility and/or anatomical anomalies.OBJECTIVE: To determine the motor and anatomical causes of dysphagia.METHODS: A total of 41 adults, followed at the Esophageal Atresia Clinic atHôpital Saint-Luc(Montreal, Quebec), were approached to particpate in the present prospective study. Evaluation was completed using upper endoscopy, manometry and barium swallow for the participants who consented. The medical charts of respondents were systematically reviewed from the neonatal period to 18 years of age to assess medical and surgical history.RESULTS: All 41 patients followed at the clinic consented and were included in the study. Dysphagia was present in 73% of patients. Esophagogastroduodenoscopy was performed in 32 patients: hiatal hernia was present in 62% (n=20); esophageal diverticulum in 13% (n=4); macroscopic Barrett esophagus in 31% (n=10); and esophagitis in 19% (n=6). Histological esophagitis was present in 20% and intestinal metaplasia in 10%. There were no cases of dysplagia or adenocarcinoma. Esophageal manometry was performed on 56% of the patients (n=23). Manometry revealed hypomotility in 100% of patients and included an insufficient number of peristaltic waves in 96%, non-propagating peristalsis in 78% and low-wave amplitude in 95%. Complete aperistalsis was present in 78%. The lower esophageal sphincter was abnormal in 12 (52%) patients, with incomplete relaxation the most common anomaly. Of the 41 patients, 29 (71%) consented to a barium swallow, which was abnormal in 13 (45%). The anomalies found were short esophageal dilation in 28%, delay in esophageal emptying in 14%, diverticula in 14% and stenosis in 7% of patients. There was more than one anomaly in 14% of patients.CONCLUSION: Dysphagia was a highly prevalent symptom in adults who underwent surgery for esophageal atresia. The present study is the first to demonstrate that motor and anatomical abnormalities may be implicated in causes of dysphagia in this population. Furthermore, these anomalies may be demonstrated with simple investigations such as endoscopy, manometry and barium swallow.

Dysmotility in Esophageal Atresia: Pathophysiology, Characterization, and Treatment

“…It is found in children (2, 3, 7, 14, 15, 17, 27–30) and persist throughout life as demonstrated by adult studies (4, 11–13, 15, 16). Esophageal dysmotility in EA was recently described using high-resolution manometry (HREM) with three types of abnormalities observed: aperistalsis (Figure 1), isolated distal contractions (Figure 2), and pressurization (2, 3, 19).…”

“…Esophageal motility has been assessed in children and adults with EA by esophageal manometry [water perfused (4, 11–16) or high resolution (2, 3, 7, 17–19)], impedancemetry (19, 20), or videofluoroscopy (21, 22). Studies have reported anomalies at each level of the esophagus including larynx and vocal cords (23–25) and gastric motor function (15, 26).…”

Quality of Life after Surgical Treatment for Esophageal Atresia: Long-Term Outcome of 154 Patients

“…Huynh Trudeau et al (2015) found dysphagia in 73% of EA/ TEF adult patients. 21 Dysphagia is most likely caused by a certain dysmotility or by anatomic anomalies.…”

“…Huynh Trudeau et al (2015) found dysphagia in 73% of EA/ TEF adult patients. 21 Dysphagia is most likely caused by a certain dysmotility or by anatomic anomalies. 21 Overall, dysphagia is a well-known long-term complication contributing to EA/TEF morbidity and may impair routine family life to the outer extend in that EA/TEF patients deny regular eating.…”

“…21 Dysphagia is most likely caused by a certain dysmotility or by anatomic anomalies. 21 Overall, dysphagia is a well-known long-term complication contributing to EA/TEF morbidity and may impair routine family life to the outer extend in that EA/TEF patients deny regular eating. In our cohort, EA/TEF type IIIb patients enjoyed eating at the age of 8 months, and EA/TEF types II and IV patients at the median age of 12 months on average.…”