Abstract
Objective: Aim of the study was to document the incidence of gastric and intestinal metaplasia
(Barrett's esophagus) in a closely followed group with EA/TEF, determine the efficacy
of pH probe studies in diagnosing reflux and, moreover, to determine the lag period
between the development of gastroesophageal reflux disease (GERD) and metaplasia.
Materials and Methods: Patients who underwent EA/TEF correction were followed up over an 18-year period
(1990–2009) with regular pH probe and endoscopy investigations. Biopsies were performed
at 3 year intervals to evaluate for metaplastic changes in the esophageal epithelium.
The interval between esophageal atresia correction and the development of erosive
esophagitis, gastric metaplasia and Barrett's esophagus was determined. The development
of complicated GERD was statistically correlated to age at detection.
Results: 51 patients (28 male) underwent EA/TEF correction during the study period. The ages
of the children followed up ranged from 7 months to 19 years. There were 5 Type A,
44 Type C and 2 Type D fistulas. 37 patients (5 Type A, 31 Type C, 1 Type D) had documented
reflux and 14 did not. 17 (46%) of the patients with reflux underwent an anti-reflux
operation. 4 of the 17 underwent 2 or more anti-reflux procedures. 21 patients had
pH probe studies positive for reflux, 3 had negative pH probe studies after an anti-reflux
operation. 18 of the 37 patients with reflux (about 50%) needed esophageal dilatation
for either anastamotic or non-anastamotic strictures. Only 4/14 (28.5%) patients without
reflux underwent dilatations and only in their first year of life (p=NS). 15 patients
had mucosal abnormalities in endoscopic biopsies. 8 patients had gastric metaplasia
and 1 patient had Barrett's esophagus. The mean age in the group with metaplasia (gastric
and intestinal) was 13 years, which was significantly different from the mean age
of the group (5.2 years) without mucosal changes (p<0.001). 2 patients with normal
pH probe studies had metaplasia on biopsies.
Conclusion: Metaplasia arises in about 15% of patients with EA/TEF. The lag time to developing
metaplasia from the time of initial surgical correction is about 10 years. Endoscopy
and biopsies are the best way of detecting mucosal changes.
Key words
esophageal atresia - Barrett's esophagus - metaplasia - screening
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Correspondence
Dr. Sathyaprasad C. Burjonrappa
New York Medical College
Pediatric Surgery
321 Munger Pavillion
10595 Valhalla
United States
Telefon: +1 914 493 7620
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eMail: sathyabc@yahoo.com
