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How to Care for Patients with EA-TEF: The Known and the Unknown

Current Gastroenterology Reports volume 19, Article number: 65 (2017) Cite this article

Abstract

Purpose of Review

Guidelines were recently published highlighting why esophageal atresia (EA) patients are prone to complication risks, and the need for long-term follow-up. In this review, we will focus on how to investigate and treat potential complications, as well as the pros and cons of different investigative and treatment modalities, and what areas continue to need further research.

Recent Findings

EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes.

Summary

A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

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Abbreviations

BE:

Barrett’s esophagus

EA:

Esophageal atresia

EoE:

Eosinophilic esophagitis

ESPGHAN:

European Society for Pediatric Gastroenterology Hepatology and Nutrition

GERD:

Gastroesophageal reflux disease

H2RA:

Histamine-2-receptor antagonist

HGM:

Heterotopic gastric mucosa

HREM:

High-resolution manometry

NASPGHAN:

North American Society for Pediatric Gastroenterology Hepatology and Nutrition

MII:

Multichannel intraluminal impedance

PPI:

Proton pump inhibitor

SI:

Symptom Index

TEF:

Tracheoesophageal fistula

TLESR:

Transient lower esophageal sphincter relaxation

VACTERL:

Vertebral, ano-rectal malformations, cardiovascular, tracheoesophageal fistula, renal and limb anomalies

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Affiliations

  1. Division of Pediatric Gastroenterology, Neurogastroenterology and Motility Center, Pediatric Gastroenterology, Hepatology, and Nutrition, Rady Children’s Hospital, 3020 Children’s Way, MC 5030, San Diego, CA, 92123, USA

    Hayat Mousa & Maheen Hassan

  2. San Diego (UCSD) School of Medicine, University of California, San Diego, CA, USA

    Hayat Mousa & Maheen Hassan

  3. Department of Pediatric Gastroenterology, Sydney Children’s Hospital, Sydney, Australia

    Usha Krishnan

  4. Discipline of Pediatrics, School of Women’s and Children’s Health, University of New South Wales, Sydney, Australia

    Usha Krishnan

  5. Digestive Endoscopy and Surgery Unit, Bambino Gesu Children’s Hospital-IRCCS, Rome, Italy

    Luigi Dall’Oglio

  6. Aerodigestive Digestive Centre, Division of Gastroenterology and Nutrition, Boston Children’s Hospital, Boston, MA, USA

    Rachel Rosen

  7. Harvard Medical School, Harvard, MA, USA

    Rachel Rosen

  8. Department of Pediatric Gastroenterology Hepatology and Nutrition, CHU Lille, Univ. Lille, National Reference Center for Congenital Malformation of the Esophagus, F-59000, Lille, France

    Frédéric Gottrand

  9. Division of Pediatric Gastroenterology, Sainte-Justine Hospital, Montreal, QC, Canada

    Christophe Faure

  10. Department of Pediatrics, Université de Montréal, Montreal, QC, Canada

    Christophe Faure

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  1. Hayat Mousa
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  2. Usha Krishnan
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  3. Maheen Hassan
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  4. Luigi Dall’Oglio
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  5. Rachel Rosen
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  6. Frédéric Gottrand
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  7. Christophe Faure
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Correspondence to Hayat Mousa.

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Mousa, H., Krishnan, U., Hassan, M. et al. How to Care for Patients with EA-TEF: The Known and the Unknown. Curr Gastroenterol Rep 19, 65 (2017). https://doi.org/10.1007/s11894-017-0605-6

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  • DOI: https://doi.org/10.1007/s11894-017-0605-6

Keywords

  • Esophageal atresia
  • Tracheoesophageal fistula
  • Review
  • Complications
  • Gastroesophageal reflux disease
  • Multichannel intraluminal impedance
  • Anastamotic strictures
  • Eosinophilic esophagitis
  • Long-term follow-up