Long-term respiratory complications of congenital esophageal atresia with or without tracheoesophageal fistula: an update

Abstract

Despite early surgical repair, congenital esophageal atresia with or without tracheoesophageal fistula (EA ± TEF) has long-term effects on respiratory and gastrointestinal function. This review updates summarizes research published since 2003 on long-term respiratory complications in patients with a history of EA ± TEF. Pulmonary hypoplasia appears to not be rare in patients with EA ± TEF. Tracheomalacia is common and is associated with respiratory symptoms in childhood. Aspiration, associated with esophageal dysmotility and/or gastroesophageal reflux, may lead to reduced pulmonary function and bronchiectasis. Pulmonary function is generally normal, although lower than in control patients, and restrictive defects tend to be commoner than obstructive defects. Abnormal airway reactivity is common and, along with respiratory symptoms, is associated with atopy. However, the inflammatory profile in EA ± TEF patients based on bronchial biopsies and exhaled nitric oxide differs from typical allergic asthma. Recent studies suggest that in older patients, respiratory symptoms tend to be associated with atopy, but abnormal lung function tends to be associated with gastroesophageal reflux and with chest wall abnormalities. Early detection and management of aspiration may be important to help prevent decrements in pulmonary function and serious long-term complications in EA ± TEF patients.

The Multifactorial Origin of Respiratory Morbidity in Patients Surviving Neonatal Repair of Esophageal Atresia

“…Doctor-diagnosed asthma, atopy, and bronchial hyper-responsiveness also appear to be quite frequent with prevalences ranging from 16 to 65% (4, 8–15). In fact, atopy is responsible for a significant proportion of respiratory morbidity in older patients whose inflammatory profile based on bronchial biopsies and exhaled nitric oxide differs from the typical asthma patients (16). …”

Impaired VEGF Signaling in Lungs with Hypoplastic Esophageal Atresia and Effects on Branching Morphogenesis

“…Survivors of EA-TEF often suffer from chronic respiratory tract disease characterized by hoarse cough, repeated pneumonia or bronchiectasis and chronic bronchitis [20][21][22]. Peptic bronchitis, gastro-esophageal reflux or fistula stump account in part for these sequelae, but defects in the airway or lung parenchyme, or lung hypoplasia might also play a role [12,23,24].…”

Thoracoabdominal and General Surgery

“…Late complications include gastroesophageal refl ux (severe refl ux in 40 %) and recurrent chest infections, probably related to gastroesophageal refl ux [ 82 ]. Long-term respiratory complications including bronchiectasis may result from aspiration, GERD, and chest wall abnormalities [ 104 ]. Both the parents and their neonate are at risk for psychological and traumatic stress (including post-traumatic stress disorder) [ 105 ].…”