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Pulvirenti R, IJsselstjin H, Mur S, Morini F. Approaches to nutrition and feeding in congenital diaphragmatic hernia. Semin Pediatr Surg 2024; 33:151442. [PMID: 39004036 DOI: 10.1016/j.sempedsurg.2024.151442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/16/2024]
Abstract
In patients with congenital diaphragmatic hernia1, nutrition can represent a challenge both in the short and long term. Its failure to resolve can have a significant impact on multiple aspects of the lives of patients with congenital diaphragmatic hernia (CDH), ranging from lung function to neurodevelopment. In this review, we will describe the causes of nutritional problems in patients with CDH, their consequences, and possible strategies to address them.
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Affiliation(s)
- Rebecca Pulvirenti
- Department of Pediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands; Pediatric Surgery Unit, Department of Women's and Children's Health, University Hospital of Padua, Padua, Italy
| | - Hanneke IJsselstjin
- Department of Pediatric Surgery, Erasmus Medical Centre Sophia Children's Hospital, Rotterdam, the Netherlands
| | - Sebastien Mur
- Department of Neonatology, Lille University Hospital, French CDH reference center, Lille, France
| | - Francesco Morini
- Department of Maternal, Child Health and Urological Sciences, Sapienza University of Rome, Rome, Italy.
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2
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de Vos C, Dellenmark-Blom M, Sikwete FM, Sidler D, van Wyk L, Goussard P. Disease-specific quality of life as part of the long-term follow-up for children born with esophageal atresia in an academic unit in South Africa-a pilot study. Dis Esophagus 2024; 37:doae016. [PMID: 38476012 PMCID: PMC11220657 DOI: 10.1093/dote/doae016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 02/06/2024] [Accepted: 02/19/2024] [Indexed: 03/14/2024]
Abstract
As neonatal mortality rates have decreased in esophageal atresia (EA), there is a growing focus on quality of life (QoL) in these children. No study from Africa has reported on this topic. This pilot study aimed to describe disease-specific QoL in EA children and its applicability as part of long-term follow-up in an academic facility in South Africa. Disease-specific QoL in children born with EA was assessed utilizing the EA-QoL questionnaire for children aged 2-17 years during a patient-encounter. The parent-report for children aged 2-7 years compromised 17 items categorized into three domains: eating, physical health and treatment, and social isolation/stress. The 24-item EA-QL questionnaire for children aged 8-18 (child- and parent-report) explored four domains: eating, body perception, social relationships, and health and well-being. A total of 13 questionnaires for children aged 2-7 years were completed by five parents. A negative perceived impact on their child's eating was reported by 46-92% of parents, and less impact in the other two domains. A total of 27 questionnaires were completed by eight children aged 8-17 years and 10 parents. Similar percentages children and parents reported a negative impact in the eating, social relationships, and body perception domains. More than half reported a negative impact on the child's health and well-being. This study supports the concept that assessment of disease-specific QoL should play a vital role in the comprehensive follow-up approach for children born with EA. We identified that parents of younger children were more likely to report eating disorders, whereas parents of older children were more likely to report health difficulties with different perceptions when it came to the child's scar.
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Affiliation(s)
- C de Vos
- Division of Pediatric Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
- Department of Pediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - M Dellenmark-Blom
- Department of Pediatric Surgery, The Queen Silvia Children’s Hospital, Gothenberg, Sweden
| | - F M Sikwete
- Division of Pediatric Surgery, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - D Sidler
- Division of Medical Ethics and Law, Stellenbosch University, Cape Town, South Africa
| | - L van Wyk
- Department of Pediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
| | - P Goussard
- Department of Pediatrics and Child Health, Stellenbosch University and Tygerberg Hospital, Cape Town, South Africa
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Öztorun Cİ, Ulukaya Durakbaşa Ç, Soyer T, Özcan C, Fırıncı B, Demirel BD, Çiftçi İ, Parlak A, Öztan MO, Göllü Bahadır G, Akkoyun İ, Karaman A, Gül C, Şalcı G, İlhan H, Oral A, Özcan R, Özaydın S, Kılıç ŞS, Kıyan G, Erdem AO, Uzunlu O, Yıldız A, Özçakır E, Ertürk N, Erginel B, Öztaş T, Atıcı A, Mert M, Samsum H, Özen MA, Aydın E, Sancar S. Determining the Risk Factors for Anastomotic Stricture Development after Esophageal Atresia Repair: Results from the Turkish Esophageal Atresia Registry. Eur J Pediatr Surg 2024. [PMID: 38848757 DOI: 10.1055/a-2340-9078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/09/2024]
Abstract
INTRODUCTION Anastomotic stricture (AS) is the second most common complication after esophageal atresia (EA) repair. We aimed to evaluate the data in the Turkish Esophageal Atresia Registry to determine the risk factors for AS development after EA repair in a large national cohort of patients. METHODS The data between 2015 and 2021 were evaluated. Patients were enrolled into two groups according to the occurrence of AS. Patients with AS (AS group) and without AS (non-AS group) were compared according to demographic and operative features, postoperative intubation status, and postoperative complications, such as anastomotic leaks, fistula recanalization, and the presence of gastroesophageal reflux (GER). A multivariable logistic regression analysis was performed to define the risk factors for the development of AS after EA repair. RESULTS Among the 713 cases, 144 patients (20.19%) were enrolled into the AS group and 569 (79.81%) in the non-AS group. The multivariable logistic regression showed that, being a term baby (odds ratio [OR]: 1.706; p = 0.006), having a birth weight over 2,500 g (OR: 1.72; p = 0.006), presence of GER (OR: 5.267; p < 0.001), or having a recurrent tracheoesophageal fistula (TEF, OR: 4.363; p = 0.006) were the risk factors for the development of AS. CONCLUSIONS The results of our national registry demonstrate that 20% of EA patients developed AS within their first year of life. In patients with early primary anastomosis, birth weight greater than 2,500 g and presence of GER were risk factors for developing AS. When patients with delayed anastomosis were included, in addition to the previous risk factors, being a term baby, and having recurrent TEF also became risk factors. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Can İhsan Öztorun
- Department of Pediatric Surgery, Faculty of Medicine, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Çiğdem Ulukaya Durakbaşa
- Department of Pediatric Surgery, Faculty of Medicine, Istanbul Medeniyet University, İstanbul, Turkey
| | - Tutku Soyer
- Department of Pediatric Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Coşkun Özcan
- Department of Pediatric Surgery, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Binali Fırıncı
- Department of Pediatric Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Berat Dilek Demirel
- Department of Pediatric Surgery, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey
| | - İlhan Çiftçi
- Department of Pediatric Surgery, Faculty of Medicine, Selçuk University, Konya, Turkey
| | - Ayşe Parlak
- Department of Pediatric Surgery, Faculty of Medicine, Uludağ University, Bursa, Turkey
| | - Mustafa Onur Öztan
- Department of Pediatric Surgery, Faculty of Medicine, Izmir Katip Celebi University, İzmir, Turkey
| | - Gülnur Göllü Bahadır
- Department of Pediatric Surgery, Faculty of Medicine, Ankara University, Ankara, Turkey
| | - İbrahim Akkoyun
- Department of Pediatric Surgery, Konya Education and Research Hospital, Konya, Turkey
| | - Ayşe Karaman
- Department of Pediatric Surgery, University of Health Sciences Turkey, Ankara Dr Sami Ulus Children's Hospital, Ankara, Turkey
| | - Cengiz Gül
- Department of Pediatric Surgery, University of Health Sciences Turkey, Zeynep Kamil Maternity and Children Health and Research Application Center, İstanbul, Turkey
| | - Gül Şalcı
- Department of Pediatric Surgery, Faculty of Medicine, Karadeniz Technical University, Trabzon, Turkey
| | - Hüseyin İlhan
- Department of Pediatric Surgery, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir Turkey
| | - Akgün Oral
- Department of Pediatric Surgery, Dr. Behcet Uz Education and Research Hospital, Izmir, Turkey
| | - Rahşan Özcan
- Department of Pediatric Surgery, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey
| | - Seyithan Özaydın
- Department of Pediatric Surgery, University of Health Sciences Turkey, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
| | - Şeref Selçuk Kılıç
- Department of Pediatric Surgery, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Gürsu Kıyan
- Department of Pediatric Surgery, Faculty of Medicine, Maramara University, Istanbul, Turkey
| | - Ali Onur Erdem
- Department of Pediatric Surgery, Faculty of Medicine, Adnan Menderes University, Aydın, Turkey
| | - Osman Uzunlu
- Department of Pediatric Surgery, Faculty of Medicine, Pamukkale University, Denizli, Turkey
| | - Abdullah Yıldız
- Department of Pediatric Surgery, Sisli Hamidiye Etfal Education and Research Hospital, Istanbul, Turkey
| | - Esra Özçakır
- University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Bursa, Turkey
| | - Nazile Ertürk
- Department of Pediatric Surgery, Faculty of Medicine, Muğla Sıtkı Kocaman University, Muğla, Turkey
| | - Başak Erginel
- Department of Pediatric Surgery, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Tülin Öztaş
- University of Health Sciences, Diyarbakır Training and Research Hospital, Diyarbakır, Turkey
| | - Ahmet Atıcı
- Department of Pediatric Surgery, Faculty of Medicine, Mustafa Kemal University, Hatay, Turkey
| | - Mehmet Mert
- Department of Pediatric Surgery, University of Health Sciences Van Training and Research Hospital, Van, Turkey
| | - Hakan Samsum
- Department of Pediatric Surgery, Private Antakya Academy Hospital, Hatay, Turkey
| | - Mehmet Ali Özen
- Department of Pediatric Surgery, School of Medicine, Koç University, Istanbul, Turkey
| | - Emrah Aydın
- Department of Pediatric Surgery, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Serpil Sancar
- Department of Pediatric Surgery, Bursa City Hospital, Bursa, Turkey
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Amil-Dias J, Oliva S, Papadopoulou A, Thomson M, Gutiérrez-Junquera C, Kalach N, Orel R, Auth M, Nijenhuis-Hendriks D, Strisciuglio C, Bauraind O, Chong S, Ortega GD, Férnandez SF, Furman M, Garcia-Puig R, Gottrand F, Homan M, Huysentruyt K, Kostovski A, Otte S, Rea F, Roma E, Romano C, Tzivinikos C, Urbonas V, Velde SV, Zangen T, Zevit N. Diagnosis and management of eosinophilic esophagitis in children: An update from the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN). J Pediatr Gastroenterol Nutr 2024. [PMID: 38923067 DOI: 10.1002/jpn3.12188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/17/2023] [Accepted: 09/04/2023] [Indexed: 06/28/2024]
Abstract
INTRODUCTION Eosinophilic esophagitis (EoE) is a chronic inflammatory disease of the esophagus characterized by symptoms of esophageal dysfunction and histologically by predominantly eosinophilic infiltration of the squamous epithelium. European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) published a guideline in 2014; however, the rapid evolution of knowledge about pathophysiology, diagnostic criteria, and therapeutic options have made an update necessary. METHODS A consensus group of pediatric gastroenterologists from the ESPGHAN Working Group on Eosinophilic Gastrointestinal Diseases (ESPGHAN EGID WG) reviewed the recent literature and proposed statements and recommendations on 28 relevant questions about EoE. A comprehensive electronic literature search was performed in MEDLINE, EMBASE, and Cochrane databases from 2014 to 2022. The Grading of Recommendations Assessment, Development and Evaluation system was used to assess the quality of evidence and formulate recommendations. RESULTS A total of 52 statements based on the available evidence and 44 consensus-based recommendations are available. A revision of the diagnostic protocol, options for initial drug treatment, and the new concept of simplified empiric elimination diets are now available. Biologics are becoming a part of the potential armamentarium for refractory EoE, and systemic steroids may be considered as the initial treatment for esophageal strictures before esophageal dilation. The importance and assessment of quality of life and a planned transition to adult medical care are new areas addressed in this guideline. CONCLUSION Research in recent years has led to a better understanding of childhood EoE. This guideline incorporates the new findings and provides a practical guide for clinicians treating children diagnosed with EoE.
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Affiliation(s)
- Jorge Amil-Dias
- Pediatric Gastroenterology, Hospital Lusíadas, Porto, Portugal
| | - Salvatore Oliva
- Maternal and Child Health Department, University Hospital - Umberto I, Sapienza - University of Rome, Rome, Italy
| | - Alexandra Papadopoulou
- Division of Gastroenterology and Hepatology, First Department of Pediatrics, Children's hospital Agia Sofia, University of Athens, Athens, Greece
| | - Mike Thomson
- Centre for Paediatric Gastroenterology, International Academy for Paediatric Endoscopy Training, Sheffield Children's Hospital, UK
| | - Carolina Gutiérrez-Junquera
- Pediatric Gastroenterology Unit, Hospital Universitario Puerta de Hierro Majadahonda, Universidad Autónoma de Madrid, Spain
| | - Nicolas Kalach
- Department of Pediatrics, Saint Vincent de Paul Hospital, Groupement des Hôpitaux de l'Institut Catholique de Lille (GHICL), Catholic University, Lille, France
| | - Rok Orel
- Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Marcus Auth
- Alder Hey Children's NHS Foundation Trust, Liverpool, UK
| | | | - Caterina Strisciuglio
- Department of Woman, Child and General and Specialized Surgery of the University of Campania "Luigi Vanvitelli", Naples, Italy
| | | | - Sonny Chong
- Epsom and St Helier University Hospitals NHS Trust, UK
| | - Gloria Dominguez Ortega
- Pediatric Gastroenterology and Nutrition Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | - Sonia Férnandez Férnandez
- Pediatric Gastroenterology Unit, Department of Pediatrics, Severo Ochoa University Hospital, Madrid, Spain
| | - Mark Furman
- Royal Free London NHS Foundation Trust, London, UK
| | - Roger Garcia-Puig
- Pediatric Gastroenterology, Hepatology and Nutrition Unit, Pediatrics Department, Hospital Universitari MútuaTerrassa, Universitat de Barcelona, Barcelona, Spain
| | | | - Matjaz Homan
- Department of Gastroenterology, Hepatology, and Nutrition, University Children's Hospital, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Koen Huysentruyt
- Kindergastro-enterologie, hepatologie en nutritie, Brussels Centre for Intestinal Rehabilitation in Children (BCIRC), Belgium
| | - Aco Kostovski
- University Children's Hospital Skopje, Faculty of Medicine, University Ss Cyril and Methodius, Skopje, Republic of North Macedonia
| | - Sebastian Otte
- Childrens' Hospital, Helios Mariahilf Hospital, Hamburg, Germany
| | - Francesca Rea
- Endoscopy and Surgey Unit, Bambino Gesu Children's Hospital, Rome, Italy
| | - Eleftheria Roma
- First Department of Pediatrics, University of Athens and Pediatric Gastroenterology Unit Mitera Children's Hospital, Athens, Greece
| | - Claudio Romano
- Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy
| | - Christos Tzivinikos
- Paediatric Gastroenterology Department, Al Jalila Children's Specialty Hospital, Dubai, UAE
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Vaidotas Urbonas
- Vilnius University Medical Faculty Clinic of Children's Diseases, Vilnius, Lithuania
| | | | - Tsili Zangen
- Pediatric Gastroenterology Unit, Wolfson Medical Center, Holon, Israel
| | - Noam Zevit
- Eosinophilic Gastrointestinal Disease Clinic, Institute of Gastroenterology, Hepatology, and Nutrition, Schneider Children's Medical Center of Israel, Israel
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Auger N, Paradis G, Healy-Profitós J, Lewin A, Malik M, Potter BJ. Non-cardiac birth defects and long-term risk of cardiovascular hospitalisation. Heart 2024; 110:892-898. [PMID: 38772572 DOI: 10.1136/heartjnl-2023-323632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 05/04/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND Patients with heart defects are at risk of developing cardiovascular disease. Our objective was to determine if non-cardiac birth defects are associated with the risk of cardiovascular hospitalisation. METHODS We conducted a longitudinal cohort study of 1 451 409 parous women in Quebec, Canada. We compared patients with cardiac and non-cardiac birth defects of the urinary, central nervous and other systems against patients without defects between 1989 and 2022. The main outcome was hospitalisation for coronary artery disease, ischaemic stroke and other cardiovascular outcomes during 33 years of follow-up. We computed cardiovascular hospitalisation rates and used Cox proportional hazards regression models to measure the association (HR; 95% CI) between non-cardiac defects and later risk of cardiovascular hospitalisation, adjusted for patient characteristics. RESULTS Women with any birth defect had a higher rate of cardiovascular hospitalisation than women without defects (7.0 vs 3.3 per 1000 person-years). Non-cardiac defects overall were associated with 1.61 times the risk of cardiovascular hospitalisation over time, compared with no defect (95% CI 1.56 to 1.66). Isolated urinary (HR 3.93, 95% CI 3.65 to 4.23), central nervous system (HR 3.33, 95% CI 2.94 to 3.76) and digestive defects (HR 2.39, 95% CI 2.16 to 2.65) were associated with the greatest risk of cardiovascular hospitalisation. These anomalies were associated with cardiovascular hospitalisation whether they presented alone or clustered with other defects. Nevertheless, heart defects were associated with the greatest risk of cardiovascular hospitalisation (HR 10.30, 95% CI 9.86 to 10.75). CONCLUSION The findings suggest that both cardiac and non-cardiac birth defects are associated with an increased risk of developing cardiovascular disease among parous women.
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Affiliation(s)
- Nathalie Auger
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
- Department of Social and Preventive Medicine, University of Montreal, Montreal, Québec, Canada
| | - Gilles Paradis
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Jessica Healy-Profitós
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Antoine Lewin
- Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Québec, Canada
- Medical Affairs and Innovation, Hema-Quebec, Montreal, Québec, Canada
| | - Mariyam Malik
- University of Montreal Hospital Centre Research Centre, Montreal, Québec, Canada
- Institut national de santé publique du Québec, Montreal, Québec, Canada
| | - Brian J Potter
- Division of Cardiology, Department of Medicine, University of Montreal Hospital Centre, Montreal, Québec, Canada
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Tang TC, Leach ST, Krishnan U. Proton pump inhibitors, antibiotics, and atopy increase the risk of eosinophilic esophagitis in children with esophageal atresia. J Pediatr Gastroenterol Nutr 2024; 78:1317-1328. [PMID: 38409891 DOI: 10.1002/jpn3.12129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 12/20/2023] [Accepted: 12/27/2023] [Indexed: 02/28/2024]
Abstract
OBJECTIVE To determine whether proton pump inhibitor (PPI) exposure is associated with an increased risk of developing eosinophilic esophagitis (EoE) in children with esophageal atresia (EA). STUDY DESIGN A retrospective chart review of children with EA from January 1, 2005 to December 31, 2020 was undertaken at Sydney Children's Hospital Randwick. Children with EA and EoE (cases) were matched (1:2) to children with only EA (controls) to compare PPI exposure. Other early-life factors such as infantile antibiotic exposure and personal or family history of atopy were also analyzed using simple and multivariable logistic regression. RESULTS Of 184 children with EA, 46 (25%) developed EoE during this period. Thirty-eight EoE participants were matched to 76 controls. Children with EoE and EA received PPI for significantly higher durations (p = .018) and at significantly higher cumulative doses (p = .017) than controls. Food allergy (adjusted odds ratio [aOR], 7.317; 95% confidence interval [CI], 2.244-23.742), family history of atopy (aOR, 3.504; 95% CI, 1.268-9.682), and infantile antibiotic exposure (aOR, 1.040; 95% CI, 1.006-1.075) were also significantly associated with an increased risk of developing EoE in the EA cohort. CONCLUSIONS Prolonged duration and high cumulative dose of PPI exposure were significantly associated with subsequent EoE development in children with EA. Food allergy, family history of atopy, and infantile antibiotic exposure in EA were also significantly associated with an increased risk of EoE development.
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Affiliation(s)
- Tiffany C Tang
- School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Steven T Leach
- School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
| | - Usha Krishnan
- School of Clinical Medicine, Discipline of Pediatrics, Faculty of Medicine and Health, University of New South Wales, Sydney, Australia
- Department of Pediatric Gastroenterology, Sydney Children's Hospital Randwick, Sydney, Australia
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Cullis PS, Fouad D, Goldstein AM, Wong KKY, Boonthai A, Lobos P, Pakarinen MP, Losty PD. Major surgical conditions of childhood and their lifelong implications: comprehensive review. BJS Open 2024; 8:zrae028. [PMID: 38776252 PMCID: PMC11110943 DOI: 10.1093/bjsopen/zrae028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 12/18/2023] [Accepted: 01/30/2024] [Indexed: 05/24/2024] Open
Abstract
BACKGROUND In recent decades, the survival of children with congenital anomalies and paediatric cancer has improved dramatically such that there has been a steady shift towards understanding their lifelong health outcomes. Paediatric surgeons will actively manage such conditions in childhood and adolescence, however, adult surgeons must later care for these 'grown-ups' in adulthood. This article aims to highlight some of those rare disorders encountered by paediatric surgeons requiring long-term follow-up, their management in childhood and their survivorship impact, in order that the adult specialist may be better equipped with skills and knowledge to manage these patients into adulthood. METHODS A comprehensive literature review was performed to identify relevant publications. Research studies, review articles and guidelines were sought, focusing on the paediatric management and long-term outcomes of surgical conditions of childhood. The article has been written for adult surgeon readership. RESULTS This article describes the aforementioned conditions, their management in childhood and their lifelong implications, including: oesophageal atresia, tracheo-oesophageal fistula, malrotation, short bowel syndrome, duodenal atresia, gastroschisis, exomphalos, choledochal malformations, biliary atresia, Hirschsprung disease, anorectal malformations, congenital diaphragmatic hernia, congenital lung lesions and paediatric cancer. CONCLUSION The increasing survivorship of children affected by surgical conditions will translate into a growing population of adults with lifelong conditions and specialist healthcare needs. The importance of transition from childhood to adulthood is becoming realized. It is hoped that this timely review will enthuse the readership to offer care for such vulnerable patients, and to collaborate with paediatric surgeons in providing successful and seamless transitional care.
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Affiliation(s)
- Paul S Cullis
- Department of Paediatric Surgery, Royal Hospital for Children Edinburgh, Edinburgh, UK
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Dina Fouad
- Department of Paediatric Surgery, Leicester Children’s Hospital, Leicester, UK
| | - Allan M Goldstein
- Department of Paediatric Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kenneth K Y Wong
- Department of Paediatric Surgery, Queen Mary’s Hospital, University of Hong Kong, Hong Kong, Hong Kong SAR
| | - Ampaipan Boonthai
- Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Pablo Lobos
- Department of Paediatric Surgery, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Mikko P Pakarinen
- The New Children’s Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Women’s and Children’s Health, Karolinska Institute, Stockholm, Sweden
- Department of Surgery, University of Southern Denmark, Odense, Denmark
| | - Paul D Losty
- Department of Paediatric Surgery, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK
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8
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Yasuda JL, Kamran A, Servin Rojas M, Hayes C, Staffa SJ, Ngo PD, Chang D, Hamilton TE, Demehri F, Mohammed S, Zendejas B, Manfredi MA. Surveillance Endoscopy in Pediatric Esophageal Atresia: Toward an Evidence-Based Algorithm. J Am Coll Surg 2024; 238:831-843. [PMID: 38078620 DOI: 10.1097/xcs.0000000000000923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2024]
Abstract
BACKGROUND Individuals with esophageal atresia (EA) have lifelong increased risk for mucosal and structural pathology of the esophagus. The use of surveillance endoscopy to detect clinically meaningful pathology has been underexplored in pediatric EA. We hypothesized that surveillance endoscopy in pediatric EA has high clinical yield, even in the absence of symptoms. STUDY DESIGN The medical records of all patients with EA who underwent at least 1 surveillance endoscopy between March 2004 and March 2023 at an international EA referral center were retrospectively reviewed. The primary outcomes were endoscopic identification of pathology leading to an escalation in medical, endoscopic, or surgical management. Logistic regression analysis examined predictors of actionable findings. Nelson-Aalen analysis estimated optimal endoscopic surveillance intervals. RESULTS Five hundred forty-six children with EA underwent 1,473 surveillance endoscopies spanning 3,687 person-years of follow-up time. A total of 770 endoscopies (52.2%) in 394 unique patients (72.2%) had actionable pathology. Esophagitis leading to escalation of therapy was the most frequently encountered finding (484 endoscopies, 32.9%), with most esophagitis attributed to acid reflux. Barrett's esophagus (intestinal metaplasia) was identified in 7 unique patients (1.3%) at a median age of 11.3 years. No dysplastic lesions were identified. Actionable findings leading to surgical intervention were found in 55 children (30 refractory reflux and 25 tracheoesophageal fistulas). Significant predictors of actionable pathology included increasing age, long gap atresia, and hiatal hernia. Symptoms were not predictive of actionable findings, except dysphagia, which was associated with stricture. Nelson-Aalen analysis predicted occurrence of an actionable finding every 5 years. CONCLUSIONS Surveillance endoscopy uncovers high rates of actionable pathology even in asymptomatic children with EA. Based on the findings of the current study, a pediatric EA surveillance endoscopy algorithm is proposed.
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Affiliation(s)
- Jessica L Yasuda
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Ali Kamran
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Maximiliano Servin Rojas
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Cameron Hayes
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Steven J Staffa
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Peter D Ngo
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Denis Chang
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Thomas E Hamilton
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Farokh Demehri
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Somala Mohammed
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Benjamin Zendejas
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
| | - Michael A Manfredi
- From the Division of Gastroenterology, Hepatology and Nutrition (Yasuda, Ngo, Chang, Manfredi), Boston, MA
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9
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Joseph M, Corrado MM, Odiase E, Friedlander JA, Smith C, Nguyen N. Sedation-free transnasal esophagoscopy to evaluate and monitor esophageal diseases in children with esophageal atresia-tracheoesophageal fistula. JPGN REPORTS 2024; 5:166-169. [PMID: 38756140 PMCID: PMC11093930 DOI: 10.1002/jpr3.12063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 12/05/2023] [Accepted: 02/03/2024] [Indexed: 05/18/2024]
Abstract
Patients with esophageal atresia and tracheoesophageal fistula (EA-TEF) are at increased risk of conditions including gastroesophageal reflux, peptic esophagitis, gastric metaplasia, anastomotic strictures, eosinophilic esophagitis, and dysphagia. Patients with TEF-EA may need serial endoscopy in their lifetime given the known short- and long-term GI complications. There has been increased interest in pediatric unsedated transnasal endoscopy (TNE) as an endoscopic alternative as it is lower cost, has shorter recovery time, and eliminates potential risks associated with anesthesia. We report on the use of TNE with EA-TEF in four patients: One patient had gastroesophageal reflux disease, one patient had eosinophilic esophagitis and TNE was used for surveillance in two patients. Use of TNE allowed for close endoscopic monitoring and changes in medication management. The third and fourth patients underwent TNE as part of routine EA-TEF screening which is recommended by societal guidelines (Krishnan et al, J Pediatr Gastroenterol Nutr. 2016;63(5):550-570). Unsedated TNE is an alternative endoscopic approach in the management of patients with EA-TEF.
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Affiliation(s)
- Michael Joseph
- Section of Pediatric Gastroenterology, Hepatology and NutritionChildren's Hospital of Colorado, Digestive Health Institute, Children's Hospital ColoradoAuroraColoradoUSA
| | - Michelle M. Corrado
- Section of Pediatric Gastroenterology, Hepatology and NutritionChildren's Hospital of Colorado, Digestive Health Institute, Children's Hospital ColoradoAuroraColoradoUSA
| | - Eunice Odiase
- Section of Pediatric Gastroenterology, Hepatology and NutritionChildren's Hospital of Colorado, Digestive Health Institute, Children's Hospital ColoradoAuroraColoradoUSA
- Division of Pediatric Gastroenterology and Hepatology, Department of PediatricsUniversity of VirginiaCharlottesvilleVirginiaUSA
| | | | | | - Nathalie Nguyen
- Section of Pediatric Gastroenterology, Hepatology and NutritionChildren's Hospital of Colorado, Digestive Health Institute, Children's Hospital ColoradoAuroraColoradoUSA
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10
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Wolfe C, Jnah A. Tracheoesophageal Fistula With Esophageal Atresia: A Case Series. Neonatal Netw 2024; 43:65-75. [PMID: 38599775 DOI: 10.1891/nn-2023-0051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Tracheoesophageal fistula (TEF) with or without esophageal atresia (EA) results from maldevelopment of the trachea and esophagus during maturation of the primitive foregut. EA/TEF commonly presents shortly after birth because of increased oral secretions and the inability to advance a nasogastric or orogastric tube to the proper depth. Given that prenatal diagnosis is uncommon and early intervention is important to reduce morbidity and mortality risk, early recognition and diagnosis are imperative. We present a case series of two neonates diagnosed with EA/TEF, type "C" and type "E," born at low-acuity centers, who required transport to a tertiary center for surgical support. The pathophysiology as well as types of TEFs, symptomology, stabilization goals, corrective treatment, and long-term implications will be examined. Finally, the educational needs of parents and caregivers will be discussed.
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11
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Zhang N, Wu W, Zhuang Y, Wang W, Pan W, Wang J. Experience in the treatment of long-gap esophageal atresia by intraluminal esophageal stretching elongation. Front Pediatr 2024; 12:1367935. [PMID: 38523834 PMCID: PMC10957633 DOI: 10.3389/fped.2024.1367935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2024] [Accepted: 02/27/2024] [Indexed: 03/26/2024] Open
Abstract
Objective To summarize the experience with intraluminal esophageal stretching elongation (ILESE) in the successful treatment of long-gap esophageal atresia (LGEA) at a single center. Methods Clinical data of 68 neonates who underwent LGEA between February 2015 and January 2022 were retrospectively analyzed. Four patients died of multiple associated severe malformations and did not undergo ILESE. Esophageal anastomosis was successfully performed in 60 cases (93.75%) and failed in 4 cases (6.25%) treated with ILESE. The ILESE techniques, esophageal reconstruction, results, postoperative complications, and follow-up treatment were analyzed. Results The beginning time of performing ILESE preoperation was 53.4 ± 39.4 days after birth, and the age of esophageal reconstruction was 122.2 ± 70.3 days after birth in 60 cases. The gap length of proximal and distal esophageal segments which were evaluated the first time at admission was 4.8 ± 1.3 vertebral bodies, whereas the gap before anastomosis was -0.46 ± 0.90 vertebral bodies. Among the patients with esophageal primary-anastomosis, 55 received thoracoscopic surgery, and 5 underwent thoracotomy in the early stage. Of the 60 children with ILESE, 58 underwent end-to-end esophagostomy, of which 17 cases were combined with circular esophagotomy (livaditis), and 2 cases of esophageal lengthening were combined with the reversal of the ligulate loop of the proximal esophagus (flap). Overall, 59 cases were cured (98.3%), and 1 patient died of respiratory failure postoperatively. All patients were followed up for 7-96 months. Postoperative anastomotic leakage occurred in 16 patients (27.6%), all of whom were successfully treated conservatively. Anastomotic stenosis occurred in 49 cases (83.1%), all of which were successfully managed by non-surgical treatment, including 12.7 ± 9.3 times of esophageal balloon dilatation and 2 cases of stent dilatation. Gastroesophageal reflux occurred in 44 patients (74.6%), including associated or acquired esophageal hiatal hernia in 22 patients, and Nissen fundoplication was performed in 17 patients. Conclusions ILESE is an effective method for prolonging the proximal and distal esophagus of the LGEA to reconstruct esophageal continuity using its esophageal tissue, with an efficacy rate of 93.75%. Postoperative anastomotic stricture and gastroesophageal reflux are common and require long-term, standardized follow-up and treatment.
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Affiliation(s)
- Ning Zhang
- Department of Pediatric Surgery, Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
- Department of Pediatric Surgery, The Affiliated Xuzhou Children’s Hospital of Xuzhou Medical University, Xuzhou, Jiangsu, China
| | - Wenjie Wu
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yujia Zhuang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weipeng Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Weihua Pan
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Wang
- Department of Pediatric Surgery, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
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12
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Dimitrov G, Aumar M, Duhamel A, Wanneveich M, Gottrand F. Proton pump inhibitors in esophageal atresia: A systematic review and meta-analysis. J Pediatr Gastroenterol Nutr 2024; 78:457-470. [PMID: 38262739 DOI: 10.1002/jpn3.12115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/09/2023] [Accepted: 12/18/2023] [Indexed: 01/25/2024]
Abstract
Gastroesophageal reflux disease (GERD) is frequent and prolonged in esophageal atresia (EA) pediatric patients requiring routine use of proton pump inhibitors (PPIs). However, there are still controversies on the prophylactic use of PPIs and the efficacy of PPIs on GERD and EA complications in this special condition. The aim of the study is to assess the prophylactic use of PPIs in pediatric patients with EA and its complications. We, therefore, performed a systematic review including all reports on the subject from 1980 to 2022. We conducted meta-analysis of the pooled proportion of PPI-and no PPI groups using random effect model, meta-regression, and estimate heterogeneity by heterogeneity index I2 . Thirty-eight reports on the topic met the criteria selection, representing a cumulative 6044 patients with EA. Prophylactic PPI prescription during the first year of life does not appear to prevent GERD persistence at follow-up and is not associated with a significantly reduced rate of antireflux surgical procedures (ARP). PPIs improve peptic esophagitis and induce remission of eosinophilic esophagitis at a rate of 50%. Their effect on other GERD outcomes is uncertain. Evidence suggests that PPIs do not prevent anastomotic stricture, Barrett's esophagus, or respiratory complications. PPI use in EA can improve peptic and eosinophilic esophagitis but is ineffective on the other EA complications. Side effects of PPIs in EA are almost unknown.
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Affiliation(s)
- Georges Dimitrov
- Unit of Pediatric Surgery, Unit of Pediatrics, Competence Centre for Rare Esophageal Diseases, University Hospital Center of Orléans, Orléans, France
| | - Madeleine Aumar
- Reference Centre for Rare Esophageal Diseases, University of Lille, CHU Lille, Lille, France
| | - Alain Duhamel
- Biostatistics Unit, University Hospital of Lille, Lille, France
| | | | - Frédéric Gottrand
- Reference Centre for Rare Esophageal Diseases, University of Lille, CHU Lille, Lille, France
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13
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Pirzirenli MG, Büyükkarabacak Y. Surgical esophageal diseases in children. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2024; 32:S108-S118. [PMID: 38584792 PMCID: PMC10995682 DOI: 10.5606/tgkdc.dergisi.2024.25770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 01/02/2024] [Indexed: 04/09/2024]
Abstract
Pediatric age esophageal diseases are rare and complex clinical conditions. Treatment options should be individually determined for the patient. The advances in the follow-up and treatment process is the most important reason for the increase in survival time, particularly for congenital pediatric surgical diseases. This study aimed to evaluate the general characteristics of pediatric surgical esophageal diseases in light of the literature.
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Affiliation(s)
| | - Yasemin Büyükkarabacak
- Department of Thoracic Surgery, Ondokuz Mayıs University Faculty of Medicine, Samsun, Türkiye
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14
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Traini I, Chan SY, Menzies J, Hughes J, Coffey MJ, McKay IR, Ooi CY, Leach ST, Krishnan U. Intestinal dysbiosis and inflammation in children with repaired esophageal atresia. J Pediatr Gastroenterol Nutr 2024; 78:43-51. [PMID: 38291693 DOI: 10.1002/jpn3.12053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2023] [Revised: 09/23/2023] [Accepted: 09/26/2023] [Indexed: 02/01/2024]
Abstract
OBJECTIVES This study aims to compare the intestinal microbiota and intestinal inflammation of children with esophageal atresia (EA) to matched healthy controls, and to investigate the relationship between these factors and clinical outcomes. METHODS A cross-sectional study of 35 children with EA and 35 matched healthy controls (HC) from a single tertiary pediatric hospital in Australia was conducted. Demographic and dietary data were collected using surveys. Stool samples were analyzed using 16S rRNA sequencing, and fecal calprotectin measurements were used to measure intestinal inflammation. Comparisons were made between the groups, and correlations between the microbiota and clinical factors were investigated in the EA cohort. RESULTS Compared to HC, children with EA had similar alpha diversity, but beta diversity analysis revealed clustering of EA and HC cohorts. Children with EA had a significantly higher relative abundance of the order Lactobacillales, and a lower abundance of the genus uncultured Bacteroidales S24-7. Fecal calprotectin was significantly higher in children with EA compared to HC. In the EA cohort, children taking proton pump inhibitors (PPI's) had lower alpha diversity and higher calprotectin levels compared to those not taking PPI's. There was a negative correlation between calprotectin and length/height-for-age z scores, and children with higher calprotectin levels had a greater burden of gastrointestinal symptoms. CONCLUSIONS Children with EA have an altered intestinal microbiota compared to HC, which is likely related to PPI use, and may be impacting on growth and quality of life. It is important to rationalize PPI use in this cohort.
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Affiliation(s)
- Isabelle Traini
- Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Sin Y Chan
- Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Jessica Menzies
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Jennifer Hughes
- Department of Speech Pathology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Michael J Coffey
- Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Isabelle R McKay
- Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Chee Y Ooi
- Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
- Department of Gastroenterology, Sydney Children's Hospital, Randwick, New South Wales, Australia
| | - Steven T Leach
- Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
| | - Usha Krishnan
- Discipline of Pediatrics, School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Randwick, New South Wales, Australia
- Department of Gastroenterology, Sydney Children's Hospital, Randwick, New South Wales, Australia
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15
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Antoine M, Krishnan U, Manfredi M, Cervinskiene J, Viala J, Brendel J, Tzivinikos C, Vanrenterghem A, Dimitrov G, Hauser B, Laverdure N, Rohmer B, Behal H, Nicolas A, Gottrand F. Endoscopic management of esophageal mucosal bridges in children with esophageal atresia. Surg Endosc 2023; 37:9167-9172. [PMID: 37831175 PMCID: PMC10709217 DOI: 10.1007/s00464-023-10492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 09/23/2023] [Indexed: 10/14/2023]
Abstract
BACKGROUND AND STUDY AIMS Esophageal mucosal bridge (EMB) may be diagnosed at the anastomotic site in children operated on for esophageal atresia (EA) but so far only a few cases (n = 4) have been reported. This study aimed to characterize EMB in children with EA, risk factors, and treatment. PATIENTS AND METHODS This retrospective multicenter study recorded patient's characteristics, EMB diagnosis circumstances, endoscopic management, follow-up, and EMB recurrence in children with EA aged less than 18 years, compared with paired EA patients without EMB. RESULTS Thirty patients were included (60% male, 90% EA/tracheoesophageal fistula, 43% associated malformations). Compared to 44 paired controls, EMB was associated with a history of nasogastric tube feeding (31% vs. 9.1%, p = 0.02) and severe gastroesophageal reflux disease (history of fundoplication: 41.4% vs. 13.6%, p < 0.01). 77% had symptoms (food impaction and/or dysphagia). Endoscopic management was performed in 53% of patients (83% electrocoagulation) with no technical difficulties or complications. 80% of the symptomatic patients with EMB improved after endoscopic treatment, independently of anastomotic stricture dilatation or not. CONCLUSION EMB endoscopic management by electrocoagulation is safe and often leads to symptom improvement.
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Affiliation(s)
- Matthieu Antoine
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, University of Lille, Inserm, CHU Lille, U1286 - INFINITE, 59000, Lille, France.
- Lille University Jeanne de Flandre Children's Hospital, Avenue Eugène Avinée, 59000, Lille, France.
| | - Usha Krishnan
- Pediatric Gastroenterology, Sydney Children's Hospital, Sydney, Australia
- School of Women's and Children's Health, University of New South Wales, Sydney, Australia
| | - Michael Manfredi
- Gastroenterology, Hepatology & Nutrition, Boston Children's Hospital, Boston, USA
| | - Julija Cervinskiene
- Endoscopy, Children's Hospital, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | - Jérôme Viala
- Gastroentérologie Pédiatrique, Hôpital Universitaire Robert-Debré, AP-HP, Paris, France
| | - Julia Brendel
- Klinik für Kinderchirurgie, Medizinische Hochschule Hannover, Hannover, Germany
| | - Christos Tzivinikos
- Pediatric Gastroenterology and Nutrition, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates
| | | | | | - Bruno Hauser
- Gastroentérologie, Hépatologie et Nutrition Pédiatrique, UZ Brussel, Brussels, Belgique
| | - Noémie Laverdure
- Hépato-Gastroentérologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Lyon, Lyon, France
| | - Barbara Rohmer
- Hépato-Gastroentérologie et Nutrition Pédiatrique, Hôpital Femme Mère Enfant, Lyon, Lyon, France
| | - Hélène Behal
- ULR 2694 - METRICS: Évaluation des Technologies de Santé et des Pratiques Médicales, University of Lille, CHU Lille, 59000, Lille, France
| | - Audrey Nicolas
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, University of Lille, Inserm, CHU Lille, U1286 - INFINITE, 59000, Lille, France
- Lille University Jeanne de Flandre Children's Hospital, Avenue Eugène Avinée, 59000, Lille, France
| | - Frédéric Gottrand
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, University of Lille, Inserm, CHU Lille, U1286 - INFINITE, 59000, Lille, France
- Lille University Jeanne de Flandre Children's Hospital, Avenue Eugène Avinée, 59000, Lille, France
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16
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Nita AF, Chanpong A, Nikaki K, Rybak A, Thapar N, Borrelli O. Recent advances in the treatment of gastrointestinal motility disorders in children. Expert Rev Gastroenterol Hepatol 2023; 17:1285-1300. [PMID: 38096022 DOI: 10.1080/17474124.2023.2295495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 12/12/2023] [Indexed: 01/12/2024]
Abstract
INTRODUCTION Pediatric gastrointestinal motility disorders represent some of the most challenging clinical conditions with largely undefined pathogenetic pathways and therefore limited therapeutic options. Herein, we provide an overview of the recent advances in treatment options for these disorders and their clinical impact. AREAS COVERED PubMed and Medline databases were searched for relevant articles related to the treatment of achalasia, esophageal atresia, gastroparesis, PIPO and constipation published between 2017 and 2022. In this article, we review and summarize recent advances in management of gastrointestinal motility disorders in children with a particular focus on emerging therapies as well as novel diagnostic modalities that help guide their application or develop new, more targeted treatments. EXPERT OPINION Gastrointestinal motility disorders represent one of the most challenging conundrums in pediatric age and despite significant advances in investigative tools, the palette of treatment options remain limited. Overall, while pharmacological options have failed to bring a curative solution, recent advances in minimal invasive therapeutic and diagnostic techniques have emerged as potential keys to symptom and quality of life improvement, such as ENDOFLIP, POEM, cine-MRI, fecal microbiota transplantation.
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Affiliation(s)
- Andreia Florina Nita
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Atchariya Chanpong
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
- Division of Gastroenterology and Hepatology, Department of Paediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK
| | - Kornilia Nikaki
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Anna Rybak
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
| | - Nikhil Thapar
- Gastroenterology, Hepatology and Liver Transplant, Queensland Children's Hospital, Brisbane, Australia
- Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK
- School of Medicine, University of Queensland, Brisbane, Australia
- Woolworths Centre for Child Nutrition Research, Queensland University of Technology, Brisbane, Australia
| | - Osvaldo Borrelli
- Department of Pediatric Gastroenterology, Great Ormond Street Hospital, London, UK
- Stem Cells and Regenerative Medicine, UCL Institute of Child Health, London, UK
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17
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Kamran A, Smithers CJ, Izadi SN, Staffa SJ, Zurakowski D, Demehri FR, Mohammed S, Shieh HF, Ngo PD, Yasuda J, Manfredi MA, Hamilton TE, Jennings RW, Zendejas B. Surgical Treatment of Esophageal Anastomotic Stricture After Repair of Esophageal Atresia. J Pediatr Surg 2023; 58:2375-2383. [PMID: 37598047 DOI: 10.1016/j.jpedsurg.2023.07.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/17/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Anastomotic strictures (AS) after esophageal atresia (EA) repair are common. While most respond to endoscopic therapy, some become refractory and require surgical intervention, for which the outcomes are not well established. METHODS All EA children with AS who were treated surgically at two institutions (2011-2022) were retrospectively reviewed. Surgical repair was performed for those with AS that were either refractory to endoscopic therapy or clinically symptomatic and undergoing surgery for another indication. Anastomotic leak, need for repeat stricture resection, and esophageal replacement were considered poor outcomes. RESULTS 139 patients (median age: 12 months, range 1.5 months-20 years; median weight: 8.1 kg) underwent 148 anastomotic stricture repairs (100 refractory, 48 non-refractory) in the form of stricturoplasty (n = 43), segmental stricture resection with primary anastomosis (n = 96), or stricture resection with a delayed anastomosis after traction-induced lengthening (n = 9). With a median follow-up of 38 months, most children (92%) preserved their esophagus, and the majority (83%) of stricture repairs were free of poor outcomes. Only one anastomotic leak occurred in a non-refractory stricture. Of the refractory stricture repairs (n = 100), 10% developed a leak, 9% required repeat stricture resection, and 13% required esophageal replacement. On multivariable analysis, significant risk factors for any type of poor outcome included anastomotic leak, stricture length, hiatal hernia, and patient's weight. CONCLUSIONS Surgery for refractory AS is associated with inherent yet low morbidity and high rates of esophageal preservation. Surgical repair of non-refractory symptomatic AS at the time of another thoracic operation is associated with excellent outcomes. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ali Kamran
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Charles J Smithers
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Shawn N Izadi
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Steven J Staffa
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - David Zurakowski
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA; Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Hester F Shieh
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Peter D Ngo
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jessica Yasuda
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Thomas E Hamilton
- Department of General, Thoracic and Fetal Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Russell W Jennings
- Department of Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
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18
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O'Shea D, Schmoke N, Porigow C, Murray LP, Chung WK, Kattan M, Jang M, Antosy A, Middlesworth W, Khlevner J. Recent Advances in the Genetic Pathogenesis, Diagnosis, and Management of Esophageal Atresia and Tracheoesophageal Fistula: A Review. J Pediatr Gastroenterol Nutr 2023; 77:703-712. [PMID: 37771007 DOI: 10.1097/mpg.0000000000003952] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Abstract
Infants born with esophageal atresia and tracheoesophageal fistula, a complex congenital malformation occurring in 1/2500-4000 live births, may suffer threats to their cardiac, respiratory, and digestive health in addition to anomalies that may exist in the genitourinary and musculoskeletal systems. Optimal care for these patients throughout their lives is best achieved through a coordinated, multidisciplinary approach that our health care system is not always well-equipped to provide. This review, though not exhaustive, highlights the components of care that pertain to initial surgical reconstruction and subsequent diagnosis and management of the complications that are most frequently encountered. Authors from among the many specialties involved in the care of these patients summarize the current best practice with attention to the most recent advances. Assessment and improvement of quality of life and transition to adult specialists as children grow to adulthood is also reviewed.
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Affiliation(s)
- Delia O'Shea
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Nicholas Schmoke
- the Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Chloe Porigow
- the Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Laurie P Murray
- the Division of Pediatric Pulmonology, Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Wendy K Chung
- the Department of Pediatrics and Medicine, Columbia University Irving Medical Center, New York, NY
| | - Meyer Kattan
- the Division of Pediatric Pulmonology, Department of Pediatrics, Columbia University Irving Medical Center/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Minyoung Jang
- the Department of Otolaryngology Head and Neck Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Alexandra Antosy
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - William Middlesworth
- the Division of Pediatric Surgery, Department of Surgery, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Julie Khlevner
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons/NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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Krishnan U, Dumont MW, Slater H, Gold BD, Seguy D, Bouin M, Wijnen R, Dall'Oglio L, Costantini M, Koumbourlis AC, Kovesi TA, Rutter MJ, Soma M, Menzies J, Van Malleghem A, Rommel N, Dellenmark-Blom M, Wallace V, Culnane E, Slater G, Gottrand F, Faure C. The International Network on Oesophageal Atresia (INoEA) consensus guidelines on the transition of patients with oesophageal atresia-tracheoesophageal fistula. Nat Rev Gastroenterol Hepatol 2023; 20:735-755. [PMID: 37286639 DOI: 10.1038/s41575-023-00789-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 06/09/2023]
Abstract
Oesophageal atresia-tracheoesophageal fistula (EA-TEF) is a common congenital digestive disease. Patients with EA-TEF face gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life issues in childhood, adolescence and adulthood. Although consensus guidelines exist for the management of gastrointestinal, nutritional, surgical and respiratory problems in childhood, a systematic approach to the care of these patients in adolescence, during transition to adulthood and in adulthood is currently lacking. The Transition Working Group of the International Network on Oesophageal Atresia (INoEA) was charged with the task of developing uniform evidence-based guidelines for the management of complications through the transition from adolescence into adulthood. Forty-two questions addressing the diagnosis, treatment and prognosis of gastrointestinal, surgical, respiratory, otolaryngological, nutritional, psychological and quality of life complications that patients with EA-TEF face during adolescence and after the transition to adulthood were formulated. A systematic literature search was performed based on which recommendations were made. All recommendations were discussed and finalized during consensus meetings, and the group members voted on each recommendation. Expert opinion was used when no randomized controlled trials were available to support the recommendation. The list of the 42 statements, all based on expert opinion, was voted on and agreed upon.
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Affiliation(s)
- Usha Krishnan
- Department of Paediatric Gastroenterology, Sydney Children's Hospital, Sydney, New South Wales, Australia.
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia.
| | - Michael W Dumont
- University Hospitals Coventry and Warwickshire NHS Trust, Coventry, UK
| | - Hayley Slater
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Benjamin D Gold
- Children's Center for Digestive Health Care, GI Care for Kids, LLC, Atlanta, GA, USA
| | - David Seguy
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Department of Nutrition, CHU Lille, Lille, France
| | - Mikael Bouin
- University of Montreal, CHUM Research Center (CRCHUM), Montréal, Quebec, Canada
| | - Rene Wijnen
- Department of Paediatric Surgery, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, Netherlands
| | - Luigi Dall'Oglio
- Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, Rome, Italy
| | - Mario Costantini
- Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy
| | - Anastassios C Koumbourlis
- Division of Pulmonary & Sleep Medicine, Children's National Medical Center, Washington, DC, USA
- George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Thomas A Kovesi
- Deptartment of Paediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- The University of Ottawa, Ottawa, Ontario, Canada
| | - Michael J Rutter
- Division of Paediatric Otolaryngology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
- Department of Otolaryngology, University of Cincinnati, Cincinnati, OH, USA
| | - Marlene Soma
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of Otolaryngology, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | - Jessica Menzies
- Department of Nutrition and Dietetics, Sydney Children's Hospital, Sydney, New South Wales, Australia
| | | | - Nathalie Rommel
- Department of Gastroenterology, Department of Neurogastroenterology and Motility, University Hospitals Leuven, Leuven, Belgium
- Department of Neurosciences, ExpORL, Deglutology, University of Leuven, Leuven, Belgium
| | - Michaela Dellenmark-Blom
- Department of Paediatric Surgery, The Queen Silvia Children's hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Vuokko Wallace
- Department of Psychology, University of Bath, Bath, UK
- Department of Psychology, University of Eastern Finland, Joensuu, Finland
| | - Evelyn Culnane
- Transition Support Service, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Graham Slater
- EAT Oesophageal Atresia Global Support Groups e.V., Stuttgart, Germany
| | - Frederic Gottrand
- University of Lille, Reference Centre for Rare Oesophageal Diseases, CHU Lille, Lille, France
- Division of Paediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, Lille, France
- Institute for Translational Research in Inflammation INFINITE, Inserm Faculté de Médecine, Université de Lille, Lille, France
| | - Christophe Faure
- Division of Paediatric Gastroenterology & Oesophagus Development and Engineering Lab, Sainte-Justine Hospital, Montréal, Quebec, Canada
- Université de Montréal, Montréal, Quebec, Canada
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20
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Establishment of a condition-specific quality-of-life questionnaire for children born with esophageal atresia aged 2-7 across 14 countries. Front Pediatr 2023; 11:1253892. [PMID: 37936889 PMCID: PMC10626467 DOI: 10.3389/fped.2023.1253892] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/03/2023] [Indexed: 11/09/2023] Open
Abstract
Background Esophageal atresia (EA) is a rare congenital anomaly characterized by a discontinuity of the esophagus. Following surgical repair, survival rates have improved dramatically the past decenniums and today exceed 90%, but the children commonly present with esophageal and respiratory morbidity. In 2018, a condition-specific quality-of-life questionnaire for children with esophageal atresia (EA) aged 2-7 in Sweden-Germany was finalized (The EA-QOL questionnaire). The study aim was to describe the evaluation of the new translations across 12 new countries in Europe, Asia, Africa, Central-and North America. Methods Following forward-backward translation into the new languages, the 17-item EA-QOL questionnaire was tested in cognitive debriefing interviews with parents of children with EA aged 2-7. Parents rated if each item was easy to understand (clarity) and sensitive to answer (interference with personal integrity). They could skip responding to a non-applicable/problematic item and give open comments. Predefined psychometric criteria were used; item clarity ≥80%/item sensitive to answer ≤20%/item feasibility ≤5% missing item responses. The decision to modify the translation was based on native expert, patient stakeholder, and instrument developer review, and the need for harmonization between translations. Results Similar to findings in the Swedish-German cognitive debriefing, the cross-cultural analysis of input from 116 parents from 12 new countries (4-14 parents, median 9 parents/country) showed that all items in the EA-QOL questionnaire fulfilled the criteria for item clarity ≥80% and sensitive to answer (ranging from 1%-4.5%), although results varied between countries. Four items had missing responses between 5.2% and 13.4%, three within the same domain and were in line with parents' explanations. Poor translations and feasibility were improved. Conclusions Based on parent input, the collaboration between native experts, patient stakeholders, and instrument developers, a linguistic version of the EA-QOL questionnaire for children aged 2-7 for use in and across 14 countries has been established. These efforts have set the conditions for a cross-cultural field test of the EA-QOL questionnaire and will open the doors for a new chapter in outcome research, registries, and clinical practice concerning children with EA. In the long-term, this will help increase knowledge of the disease's burden, promote patient-centeredness, exchange of information between nations, and strengthen evidence-based treatments for children born with EA.
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21
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Krasaelap A, Duncan DR, Sabe RMM, Bhardwaj V, Lerner DG, Gold BD, Boesch RP, Faure C, von Allmen D, Williams D, Chiou E, DeBoer E, Hysinger E, Maybee J, Khlevner J, Larson K, Morris K, Jalali L, McSweeney M, Brigger MT, Greifer M, Rutter M, Williams N, Subramanyan RK, Ryan MJ, Acra S, Pentiuk S, Friedlander J, Sobol SE, Kaul A, Dorfman L, Darbari A, Prager JD, Rosen R, Cocjin JT, Mousa H. Pediatric Aerodigestive Medicine: Advancing Collaborative Care for Children With Oropharyngeal Dysphagia. J Pediatr Gastroenterol Nutr 2023; 77:460-467. [PMID: 37438891 DOI: 10.1097/mpg.0000000000003882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
OBJECTIVES Aerodigestive disorders encompass various pathological conditions affecting the lungs, upper airway, and gastrointestinal tract in children. While advanced care has primarily occurred in specialty centers, many children first present to general pediatric gastroenterologists with aerodigestive symptoms necessitating awareness of these conditions. At the 2021 Annual North American Society for Pediatric Gastroenterology, Hepatology and Nutrition meeting, the aerodigestive Special Interest Group held a full-day symposium entitled, Pediatric Aerodigestive Medicine: Advancing Collaborative Care of Children with Aerodigestive Disorders. The symposium aimed to underline the significance of a multidisciplinary approach to achieve better outcomes for these complex patients. METHODS The symposium brought together leading experts to highlight the growing aerodigestive field, promote new scientific and therapeutic strategies, share the structure and benefits of a multidisciplinary approach in diagnosing common and rare aerodigestive disorders, and foster multidisciplinary discussion of complex cases while highlighting the range of therapeutic and diagnostic options. In this article, we showcase the diagnostic and therapeutic approach to oropharyngeal dysphagia (OPD), one of the most common aerodigestive conditions, emphasizing the role of a collaborative model. CONCLUSIONS The aerodigestive field has made significant progress and continues to grow due to a unique multidisciplinary, collaborative model of care for these conditions. Despite diagnostic and therapeutic challenges, the multidisciplinary approach has enabled and greatly improved efficient, high-quality, and evidence-based care for patients, including those with OPD.
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Affiliation(s)
- Amornluck Krasaelap
- From the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Mercy Kansas City, Kansas City, MO
| | - Daniel R Duncan
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Ramy M M Sabe
- the Department of Pediatric Gastroenterology, Hepatology and Nutrition, University Hospitals Rainbow Babies and Children's Hospital, Cleveland, OH
| | - Vrinda Bhardwaj
- the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Los Angeles, CA
| | - Diana G Lerner
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Medical College of Wisconsin, Milwaukee, WI
| | - Benjamin D Gold
- the Children's Center for Digestive Health Care, LLC, GI Care for Kids, LLC, Aerodigestive Center and Program, Children's Healthcare of Atlanta, Atlanta, GA
| | - Richard Paul Boesch
- the Division of Pediatric Pulmonology, Department of Pediatrics and Adolescent Medicine, Mayo Clinic Children's Center, Rochester, MN
| | - Christophe Faure
- the Division of Pediatric Gastroenterology, Sainte-Justine University Health Center, Université de Montréal, Montréal, QC, Canada
| | - Daniel von Allmen
- the Division of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Dana Williams
- the Department of Pediatric Gastroenterology and Nutrition, Phoenix Children's Hospital, Phoenix, AZ
| | - Eric Chiou
- the Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, Houston, TX
| | - Emily DeBoer
- the Department of Pediatrics, Section of Pulmonary and Sleep Medicine, Children's Hospital Colorado Breathing Institute, University of Colorado Denver, Aurora, CO
| | - Erik Hysinger
- Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Jennifer Maybee
- Children's Hospital Colorado, University of Colorado, Aurora, CO
| | - Julie Khlevner
- the Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons and NewYork-Presbyterian, New York, NY
| | - Kara Larson
- the Division of Otolaryngology, Boston Children's Hospital, Boston, MA
| | - Kimberly Morris
- the Department of Speech Pathology, Rady Children's Hospital, San Diego, CA
| | - Lauren Jalali
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Maireade McSweeney
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Matthew T Brigger
- the Division of Pediatric Otolaryngology, Department of Surgery, Rady Children's Hospital San Diego, University of California San Diego, San Diego, CA
| | - Melanie Greifer
- the Department of Pediatrics, Division of Pediatric Gastroenterology, New York University Grossman School of Medicine, New York, NY
| | - Michael Rutter
- the Division of Pediatric Otolaryngology, Aerodigestive and Esophageal Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Nina Williams
- the Center for Airway Disorders, Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, MA
| | - Ram Kumar Subramanyan
- the University of Nebraska Medical Center, Children's Hospital and Medical Center, Omaha, NE
| | - Matthew J Ryan
- the Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Sari Acra
- the Division of Pediatric Gastroenterology, Hepatology and Nutrition, Vanderbilt University Medical Center, Nashville, TN
| | - Scott Pentiuk
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Steven E Sobol
- the Division of Otolaryngology, Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - Ajay Kaul
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Lev Dorfman
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Anil Darbari
- Children's National Hospital, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Jeremy D Prager
- the Department of Otolaryngology, University of Colorado School of Medicine; Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO
| | - Rachel Rosen
- the Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Jose T Cocjin
- the Division of Pediatric Gastroenterology, Sainte-Justine University Health Center, Université de Montréal, Montréal, QC, Canada
| | - Hayat Mousa
- the Division of Gastroenterology, Hepatology and Nutrition, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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22
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Wyllie T, Folaranmi E, Sekaran P, Watkins WJ, Chakraborty M. Prophylactic Acid-suppression Medication to Prevent Anastomotic Strictures After Oesophageal Atresia Surgery: A Systematic Review and Meta-analysis. J Pediatr Surg 2023; 58:1954-1962. [PMID: 37355433 DOI: 10.1016/j.jpedsurg.2023.05.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/15/2023] [Accepted: 05/26/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Anastomotic stricture is a common postoperative complication of oesophageal atresia ± tracheoesophageal fistula (OA/TOF) repair. Acid gastro-oesophageal reflux disease (GORD) is considered to be a factor in stricture formation and acid suppression medication is recommended post-operatively in consensus guidance. We aimed to investigate whether patients who were treated prophylactically with acid suppression medication had a reduced incidence of strictures compared to those who did not receive it. METHODS A systematic review of studies was performed, searching multiple databases without language or date restrictions. Multiple reviewers independently assessed study eligibility and literature quality. The primary outcome was anastomotic stricture formation, with secondary outcomes of GORD, anastomotic leak, and oesophagitis. Meta-analysis was performed using a random effects model, and the results were expressed as an odds ratio (OR) with 95% confidence intervals (CI). RESULTS No randomised studies on the topic were identified. Twelve observational studies were included in the analysis with ten reporting the primary outcome. The quality assessment showed a high risk of bias in several papers, predominantly due to non-objective methods of assessment of oesophageal stricture and the non-prospective, non-randomised nature of the studies. Overall, 1395 patients were evaluated, of which 753 received acid suppression medication. Meta-analysis revealed a trend towards increased odds of anastomotic strictures in infants receiving prophylactic medication, but this was not statistically significant (OR 1.33; 95% CI 0.92, 1.92). No significant differences were found in secondary outcomes. CONCLUSIONS This meta-analysis found no evidence of a statistically significant link between the prophylactic prescribing of acid suppression medication and the risk of developing anastomotic stricture after OA repair. The literature in this area is limited to observational studies and a randomised controlled trial is recommended to explore this question. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Thomas Wyllie
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK
| | - Eniola Folaranmi
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK
| | - Prabhu Sekaran
- Department of Paediatric Surgery, University Hospital of Wales, Cardiff, UK
| | - W John Watkins
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, UK
| | - Mallinath Chakraborty
- Regional Neonatal Intensive Care Unit, University Hospital of Wales, Cardiff, UK; Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, UK.
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23
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Nakagawa Y, Uchida H, Hinoki A, Shirota C, Sumida W, Makita S, Yokota K, Amano H, Yasui A, Kato D, Gohda Y, Maeda T. Refractory esophageal anastomotic stricture after esophageal atresia surgery improved with retrograde balloon dilatation through gastrostomy followed by laparoscopic fundoplication: a case report. Surg Case Rep 2023; 9:169. [PMID: 37737524 PMCID: PMC10516835 DOI: 10.1186/s40792-023-01754-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/17/2023] [Indexed: 09/23/2023] Open
Abstract
BACKGROUND An esophageal anastomotic stricture (EAS) after an esophageal atresia surgery occurs in approximately 4-60% of the cases, and its first-line therapy includes balloon dilatation. Oral balloon dilatation cannot be performed in some EAS cases; conversely, even if dilatation is possible, these strictures recur in some cases, necessitating a surgical procedure for repairing the stenosis. However, these procedures are invasive and have short- and long-term complications. If an EAS recurs repeatedly after multiple balloon dilations, gastroesophageal reflux disease (GERD) may be the underlying cause. A fundoplication procedure may be effective for treating a refractory EAS, as in the present case. CASE PRESENTATION A neonatal patient with type D esophageal atresia underwent thoracoscopic esophago-esophageal anastomosis at the age of 1 day, and her postoperative course was uneventful. Thereafter, the patient underwent gastrostomy for poor oral intake at the age of 3 months. After gastrostomy, the patient presented with a complete obstructive EAS. Balloon dilatation via the oral route was attempted; however, a guidewire could not be inserted into the EAS site. Hence, retrograde balloon dilatation via gastrostomy was performed successfully. However, the EAS recurred easily thereafter, and laparoscopic anti-reflux surgery was performed to prevent GERD. The anti-reflux surgery cured the otherwise refractory EAS and prevented its recurrence. CONCLUSIONS Retrograde balloon dilatation is another treatment option for an EAS. When an EAS recurs soon after dilatation, the patient must be evaluated for GERD; if severe GERD is observed, an appropriate anti-reflux surgery is required before dilating the EAS.
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Affiliation(s)
- Yoichi Nakagawa
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hiroo Uchida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan.
| | - Akinari Hinoki
- Department of Rare/Intractable Cancer Analysis Research, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Chiyoe Shirota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Wataru Sumida
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Satoshi Makita
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Kazuki Yokota
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Hizuru Amano
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Akihiro Yasui
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Daiki Kato
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Yousuke Gohda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
| | - Takuya Maeda
- Department of Pediatric Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8550, Japan
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24
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Tan J, Jeffries S, Carr R. A Review of Histamine-2 Receptor Antagonist and Proton Pump Inhibitor Therapy for Gastroesophageal Reflux Disease in Neonates and Infants. Paediatr Drugs 2023; 25:557-576. [PMID: 37458926 DOI: 10.1007/s40272-023-00580-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/18/2023] [Indexed: 08/11/2023]
Abstract
Proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA) are commonly used medications in neonates and infants for the treatment of gastroesophageal reflux disease (GERD), especially in neonatal intensive care units (NICUs). A literature review was conducted to evaluate the efficacy and safety of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) in preterm neonates, term neonates, and infants. A total of 27 studies were included in this review. Antacid medications in studies have consistently shown positive pharmacodynamic effects, including increasing gastric pH, reducing the reflux index, and reducing the number of acidic reflux events. The benefit found in placebo-controlled trials are limited exclusively to these surrogate outcomes. The actual clinically salient outcomes which H2RAs and PPIs are used for, such as reduction in GERD symptoms, especially irritability and improved feed tolerance and weight gain, have consistently shown no clinical benefit. H2RAs and PPIs appear to be extremely well tolerated by the neonatal and infant populations, which would mimic our experience with these medications in our unit. The available data from large, retrospective cohort and case-control studies paint a much more concerning picture regarding the potential for an increased risk in the development of allergies, anaphylactic reactions, necrotizing enterocolitis (NEC), other nosocomial infections, and lower respiratory tract infections. Given the risks associated with and lack of clinical effectiveness of both H2RAs and PPIs, use of these medications should be limited to specific clinical situations. Further studies are required to determine whether antacid pharmacologic therapy might benefit certain neonates and infants, such as those with complex medical issues.
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Affiliation(s)
- Jason Tan
- BC Children's and Women's Hospital, Pharmacy, Vancouver, BC, Canada.
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada.
| | - Sonia Jeffries
- BC Children's and Women's Hospital, Pharmacy, Vancouver, BC, Canada
| | - Roxane Carr
- BC Children's and Women's Hospital, Pharmacy, Vancouver, BC, Canada
- University of British Columbia, Faculty of Pharmaceutical Sciences, Vancouver, BC, Canada
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25
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Riddle S, Karpen H. Special Populations-Surgical Infants. Clin Perinatol 2023; 50:715-728. [PMID: 37536774 DOI: 10.1016/j.clp.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
Congenital gastrointestinal disorders and other surgical diagnoses share many common problems: increased nutritional requirements to prevent catabolism, enhance wound healing, and provide optimal growth; impaired motility and altered intestinal flora leading to feeding intolerance requiring long-term parenteral nutrition; gastroesophageal reflux and poor feeding mechanics requiring tube feedings and support; growth failure; poor barrier function and risk of infection; and other long-term sequelae. Consequently, the surgical "at-risk" infant requires specialized nutritional support to meet their increased requirements to ensure adequate growth and meet the increased demands from critical illness.
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Affiliation(s)
- Stefanie Riddle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA.
| | - Heidi Karpen
- Emory University School of Medicine/Children's Healthcare of Atlanta, 2015 Uppergate Drive Northeast, ECC Room 324, Atlanta, GA 30322, USA
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26
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Patterson KN, Beyene TJ, Gil LA, Minneci PC, Deans KJ, Halaweish I. Procedural and Surgical Interventions for Esophageal Stricture Secondary to Caustic Ingestion in Children. J Pediatr Surg 2023; 58:1631-1639. [PMID: 36878759 DOI: 10.1016/j.jpedsurg.2023.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 01/24/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
BACKGROUND Esophageal injury after caustic ingestion can vary in severity and may result in significant long-term morbidity due to stricture development. The optimal management remains unknown. We aim to determine the incidence of esophageal stricture due to caustic ingestion and quantify current procedural and operative management strategies. METHODS The Pediatric Health Information System (PHIS) was utilized to identify patients 0-18 years old who experienced caustic ingestion from January 2007-September 2015 and developed subsequent esophageal stricture until December 2021. Post-injury procedural and operative management was identified utilizing ICD-9/10 procedure codes for esophagogastroduodenoscopy (EGD), esophageal dilation, gastrostomy tube placement, fundoplication, tracheostomy, and major esophageal surgery. RESULTS 1,588 patients from 40 hospitals experienced caustic ingestion of which 56.6% were male, 32.5% non-Hispanic White, and the median age at time of injury was 2.2 years (IQR: 1.4,4.8). Median length of initial admission was 1.0 day (IQR: 1.0, 3.0). 171/1,588 (10.8%) developed esophageal stricture. Among those who developed stricture, 144 (84.2%) underwent at least 1 additional EGD, 138 (80.7%) underwent dilation, 70 (40.9%) underwent gastrostomy tube, 6 (3.5%) underwent fundoplication, 10 (5.8%) underwent tracheostomy, and 40 (23.4%) underwent major esophageal surgery. Patients underwent a median of 9 dilations (IQR 3, 20). Major surgery was performed at a median of 208 (IQR: 74, 480) days after caustic ingestion. CONCLUSION Many patients with esophageal stricture after caustic ingestion will require multiple procedural interventions and potentially major surgery. These patients may benefit from early multi-disciplinary care coordination and the development of a best-practice treatment algorithm. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Kelli N Patterson
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Tariku J Beyene
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Lindsay A Gil
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Peter C Minneci
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Katherine J Deans
- Center for Surgical Outcomes Research, The Research Institute at Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA; Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Ihab Halaweish
- Department of Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
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Dellenmark-Blom M, Ax SÖ, Lilja HE, Reilly C, Svensson JF, Kassa AM, Jönsson L, Abrahamsson K, Gatzinsky V, Omling E, Tollne A, Stenström P, Öst E. Prevalence of Mental Health Problems, Associated Factors, and Health-Related Quality of Life in Children with Long-Gap Esophageal Atresia in Sweden. J Pediatr Surg 2023; 58:1646-1655. [PMID: 36635161 DOI: 10.1016/j.jpedsurg.2022.12.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/21/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Children with long-gap esophageal atresia (LGEA) face a high risk of digestive and respiratory morbidity, but their mental health outcomes have not been investigated. We aimed to identify the prevalence of mental health problems in children with LGEA, associated factors and health-related quality of life (HRQOL). METHODS Twenty-six children with LGEA aged 3-17 were recruited nationwide in Sweden. One of their parents and adolescents aged 11-17 completed information on the child's mental health (Strength and Difficulties Questionnaire), generic (PedsQL 4.0) and condition-specific HRQOL (EA-QOL). Parents gave information on current child symptomatology. Mental health level was determined using validated norms; abnormal≥90 percentile/borderline≥80 percentile/normal. Elevated levels were considered borderline/abnormal. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05. RESULTS Twelve children with LGEA aged 3-17 (46%) had elevated scores of ≥1 mental health domain in parent-reports, whereas 2 adolescents (15%) in self-reports. In parent-reports, 31% of the children had elevated levels of peer relationship problems, with associated factors being child sex male (p = 0.037), airway infections (p = 0.002) and disturbed night sleep (p = 0.025). Similarly, 31% showed elevated levels of hyperactivity/inattention, and associated factors were male sex (p = 0.005), asthma (p = 0.028) and disturbed night sleep (p = 0.036). Elevated levels of emotional symptoms, seen in 20%, were related to swallowing difficulties (p = 0.038) and vomiting problems (p = 0.045). Mental health problems correlated negatively with many HRQOL domains (p < 0.05). CONCLUSIONS Children with LGEA risk mental health difficulties according to parent-reports, especially peer relationship problems and hyperactivity/inattention, with main risk factors being male sex, airway problems and sleep disturbances. This should be considered in follow-up care and research, particularly since their mental health problems may impair HRQOL. LEVELS OF EVIDENCE Prognosis study, LEVEL II.
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Affiliation(s)
- Michaela Dellenmark-Blom
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Sofie Örnö Ax
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Helene Engstrand Lilja
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Colin Reilly
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden
| | - Jan F Svensson
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ann-Marie Kassa
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden; Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Linus Jönsson
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kate Abrahamsson
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Vladimir Gatzinsky
- Institute of Clinical Sciences, Department of Pediatrics, Queen Silvia Children's Hospital, Gothenburg, Sweden; Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Erik Omling
- Department of Pediatric Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - AnnaMaria Tollne
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Pernilla Stenström
- Department of Pediatric Surgery, Skane University Hospital, Lund University, Lund, Sweden
| | - Elin Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Walker H, Salim A, Smith C, Murphy F. Developing balloon dilatation sizing guidance for anastomotic stricture dilatation following oesophageal atresia repair. Pediatr Surg Int 2023; 39:252. [PMID: 37624471 DOI: 10.1007/s00383-023-05536-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/07/2023] [Indexed: 08/26/2023]
Abstract
PURPOSE To develop guidance for the selection of balloon catheter size when performing an oesophageal dilatation for a stricture post oesophageal atresia repair. METHODS This was a single centre retrospective study at a paediatric tertiary centre. Dilatations were performed between 2015 and 2020. All dilatations were performed under general anaesthesia using balloon catheters under fluoroscopic guidance. Outliers were excluded using ROUT method and descriptive analysis was calculated to 1SD or IQR depending on the normality of data distribution. RESULTS 97 patients underwent 341 dilatations. Median age was 19 months (37 weeks corrected gestation-17 years), median weight was 10.7 kg (2.6-72 kg). Balloon catheter sizes ranged from 6-8 mm to 18-20 mm. There was strong correlation between weight and balloon size (r = 0.8, p < 0.0001). There were 2 perforations (0.6%), both diagnosed intra-operatively and treated conservatively. From the results, weight recommendations were created for each balloon size. CONCLUSION Fluoroscopic balloon dilatation is a safe and effective method to treat anastomotic stricture following oesophageal atresia repair. Previous studies have shown correlation between patient weight and oesophageal diameter. We propose guidance for using an appropriate balloon size based on patient's weight with the aim to reduce complication.
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Affiliation(s)
- Hamish Walker
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, UK.
| | - Adeline Salim
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, UK
| | - Charlotte Smith
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, UK
| | - Fiona Murphy
- Department of Paediatric Surgery, Alder Hey Children's NHS Foundation Trust, Eaton Rd, Liverpool, L12 2AP, UK
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Örnö Ax S, Dellenmark-Blom M, Abrahamsson K, Jönsson L, Gatzinsky V. The association of feeding difficulties and generic health-related quality of life among children born with esophageal atresia. Orphanet J Rare Dis 2023; 18:237. [PMID: 37559149 PMCID: PMC10410866 DOI: 10.1186/s13023-023-02836-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 07/18/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Children born with esophageal atresia experience feeding difficulties. This study investigates the association of feeding difficulties and generic health-related quality of life among children aged 2-7 and 8-17 years, born with esophageal atresia. METHODS 108 families (n = 36 aged 2-7 years; n = 72 aged 8-17) answered a survey regarding difficulties in their child's mealtimes and a validated generic health-related quality of life instrument(PedsQL 4.0). Clinical data was collected from hospital records. The association of feeding difficulties and health-related quality of life was analysed trough Mann-Whitney U-test. Linear regression determined whether the number of concurrent feeding difficulties in the child decreased the health-related quality of life scores. P < 0.05 was considered significant. RESULTS In children aged 2-7 and 8-17 years, to have a gastrostomy, to use a food infusion pump, need for energy-enriched food and eating small portions were respectively significantly associated with lower total health-related quality of life scores in the parent-reports (p < 0.05). Most of the feeding difficulties had a negative significant relationship with the domains of physical and social functioning. Additionally, in the older age group, long mealtimes and adult mealtime supervision were associated with lower scores in both child and parent reports. In both age groups, an increased number of feeding difficulties in the child decreased the total generic health-related quality of life scores (p < 0.01). CONCLUSION Specific feeding difficulties are associated with low health-related quality of life among children with esophageal atresia. An increasing number of feeding difficulties is associated to decreasing health-related quality of life-scores. Further research is needed to understand these associations.
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Affiliation(s)
- Sofie Örnö Ax
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, Gothenburg, 416 85, Sweden.
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sverige.
| | - Michaela Dellenmark-Blom
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, Gothenburg, 416 85, Sweden
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sverige
| | - Kate Abrahamsson
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, Gothenburg, 416 85, Sweden
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sverige
| | - Linus Jönsson
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, Gothenburg, 416 85, Sweden
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sverige
| | - Vladimir Gatzinsky
- Department of Pediatrics, Institute of Clinical Sciences, The Queen Silvia Children's Hospital, Gothenburg University, Gothenburg, 416 85, Sweden
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sverige
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30
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Dellenmark-Blom M, Reilly C, Öst E, Örnö Ax S, Svensson JF, Kassa AM, Jönsson L, Abrahamsson K, Gatzinsky V, Tollne AM, Omling E, Stenström P, Engstrand Lilja H. Schooling experiences in children with long-gap esophageal atresia compared with children with esophageal atresia and primary anastomosis: a Swedish study. Orphanet J Rare Dis 2023; 18:233. [PMID: 37550744 PMCID: PMC10408199 DOI: 10.1186/s13023-023-02846-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/26/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Children with long-gap esophageal atresia (LGEA) risk living with aerodigestive morbidity and mental health difficulties. No previous study has investigated their experiences of schooling, despite the importance of schools in children's development, learning and social relationships. We aimed to describe experiences of schooling in children with LGEA in Sweden in comparison with children with EA who had primary anastomosis. METHOD Children with LGEA aged 3-17 were recruited nationwide in Sweden. One parent completed a survey on their child's school-based supports (according to definitions from the Swedish National Agency for Education), school absence, school satisfaction, school functioning (PedsQL 4.0), mental health (Strength and Difficulties Questionnaire) and current symptomatology. School data were compared between 26 children with LGEA to that from 95 children with EA who had PA, a hypothesized milder affected group. Mental health level was determined using validated norms; abnormal ≥ 90 percentile. Data were analyzed using descriptives, correlation and Mann-Whitney-U test. Significance level was p < 0.05. RESULTS Formal school-based support was reported in 17 (65.4%) children with LGEA and concerned support with nutritional intake (60%), education (50%) and medical/special health needs (35%). The prevalence of school-based support was significantly higher compared to children with PA overall (36.8%, p = 0.013) and regarding nutritional intake support (20%, p < 0.001). In children with LGEA, school-based support was related to low birth weight (p = 0.036), young child age (p = 0.014), height ≤ -2SD for age/sex (p = 0.024) and an increased number of aerodigestive symptoms (p < 0.05). All children with LGEA who had abnormal mental health scores had school-based support, except for one child. Nine children with LGEA (36%) had school absence ≥ 1times/month the past year, more frequently because of colds/airway infections (p = 0.045) and GI-specific problems compared to PA (p = 0.003). School functioning scores were not significantly different from children with PA (p = 0.34) but correlated negatively with school-based support (< 0.001) and school absence (p = 0.002). One parent out of 26 reported their child's school satisfaction as "not good". CONCLUSIONS Children with LGEA commonly receive school-based support, reflecting multifaceted daily needs and disease severity. School absence is frequent and related to poorer school functioning. Future research focusing on academic achievement in children with EA is needed.
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Affiliation(s)
- M Dellenmark-Blom
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden.
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden.
| | - C Reilly
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - E Öst
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - S Örnö Ax
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - J F Svensson
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - A-M Kassa
- Department of Pediatric Surgery, University Children's Hospital, Uppsala, Sweden
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - L Jönsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - K Abrahamsson
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - V Gatzinsky
- Department of Pediatric Surgery, Queen Silvia Children's Hospital, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Pediatrics, Institute of Clinical Sciences, Queen Silvia Children's Hospital, Gothenburg University, 416 85, Gothenburg, Sweden
| | - A M Tollne
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - E Omling
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skane University Hospital Lund, Lund, Sweden
| | - P Stenström
- Department of Pediatrics, Clinical Sciences, Lund University, Lund, Sweden
- Department of Pediatric Surgery, Skane University Hospital Lund, Lund, Sweden
| | - H Engstrand Lilja
- Department of Pediatric Surgery, Karolinska University Hospital, Stockholm, Sweden
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Tambucci R, Roversi M, Rea F, Malamisura M, Angelino G, Biondi I, Simeoli R, Goffredo BM, Francalanci P, Simonetti A, Livadiotti S, Corsetti T, Dall'Oglio L, Rossi P, Pontrelli G, De Angelis P. Oral Viscous Budesonide in Children With Eosinophilic Esophagitis After Repaired Esophageal Atresia: A Clinical Trial. J Pediatr Gastroenterol Nutr 2023; 77:249-255. [PMID: 37195886 DOI: 10.1097/mpg.0000000000003830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
OBJECTIVES A high prevalence of eosinophilic esophagitis (EoE) has been reported in children with repaired esophageal atresia (EA). Topical steroids proved to be an effective and safe therapy in EoE, although not approved in pediatrics. We report the results of the first clinical trial of oral viscous budesonide (OVB) performed in children with EoE after repaired esophageal atresia (EoE-EA). METHODS This open-label, single-arm, phase 2 clinical trial with randomized pharmacokinetic sampling, was conducted at the Bambino Gesù Children's Hospital between September 2019 and June 2021. EoE-EA patients received an age-banded dose of OVB twice daily for 12 weeks and were endoscopically evaluated. The primary endpoint was the rate of patients achieving histological remission. Secondary endpoints included clinical and endoscopic benefit after treatment, and safety assessments. RESULTS Eight consecutive EA-EoE patients were enrolled (median age 9.1 years, interquartile range 5.5). Of these, 5 received 0.8 mg and 3 received 1.0 mg twice daily of OVB. Histological remission was obtained in all but 1 patient (87.5%). The clinical score showed significant improvement at the end of treatment in all patients. No endoscopic features of EoE were found after treatment. No treatment-emergent adverse event occurred. CONCLUSION OVB is an effective, safe, and well-tolerated formulation of budesonide for use in pediatric patients with EoE-EA.
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Affiliation(s)
- Renato Tambucci
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Marco Roversi
- Residency School of Pediatrics, University of Rome Tor Vergata, Rome, Italy
| | - Francesca Rea
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Monica Malamisura
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giulia Angelino
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Isabella Biondi
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Raffaele Simeoli
- the Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Bianca Maria Goffredo
- the Division of Metabolic Diseases and Drug Biology, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paola Francalanci
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Alessandra Simonetti
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Susanna Livadiotti
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Tiziana Corsetti
- the Unit of Clinical Pharmacy, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Luigi Dall'Oglio
- the Digestive Endoscopy and Surgery Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paolo Rossi
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Giuseppe Pontrelli
- the Centre of Excellence for the Development and Implementation of Medicines, Vaccines, and Medical Devices for Pediatric Use, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
| | - Paola De Angelis
- From the Digestive Endoscopy Unit, Bambino Gesù Children's Hospital IRCCS, Rome, Italy
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32
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Doval L, Rousseau V, Irtan S. Combined esophageal and duodenal atresia: A review of the literature from 1950 to 2020. Arch Pediatr 2023:S0929-693X(23)00083-0. [PMID: 37328325 DOI: 10.1016/j.arcped.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 01/23/2023] [Accepted: 05/21/2023] [Indexed: 06/18/2023]
Abstract
The combination of duodenal atresia (DA) and esophageal atresia (EA) is very rare. With improvements in prenatal sonography and the use of fetal magnetic resonance imaging (MRI), these malformations can be diagnosed in a more accurate and timely manner; polyhydramnios remains the most common sign despite having a low specificity. The high rate of associated anomalies (in 85% of cases) can also impact neonatal management and increase the morbidity rate; thus, it is of paramount importance to look for every possible associated malformation, such as VACTERL and chromosomic anomalies. The surgical management of this combination of atresias is not well defined and changes according to the patient's clinical status, the type of EA, and the other associated malformations. Management ranges from a primary approach for one of the atresias with delayed correction of the other (56.8%) to a simultaneous repair of both atresias (33.8%) with or without gastrostomy, or total abstention (9.4%). We suggest that a simultaneous approach can be safely performed on patients in good physical condition, with a birth weight over 1500 g, and with no major respiratory distress; this method begins by closing the tracheoesophageal fistula to protect the lung and then repairing the DA. The mortality rate has decreased over the years, dropping from 71% before 1980 to 24% after 2001. In this review, we present the available evidence on these conditions, focusing mostly on the epidemiology, prenatal diagnosis, neonatal management strategies, and outcome, with the aim of determining how the different clinical features and surgical approaches may impact on morbidity and mortality.
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Affiliation(s)
- Lauren Doval
- Department of Visceral and Neonatal Pediatric Surgery, APHP Hôpital Armand Trousseau, Paris, France.
| | - Véronique Rousseau
- Department of Pediatric Surgery, APHP Hôpital Necker Enfants Malades, Paris, France
| | - Sabine Irtan
- Department of Visceral and Neonatal Pediatric Surgery, APHP Hôpital Armand Trousseau, Paris, France
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Platt JM, Nettel-Aguirre A, Bjornson CL, Mitchell I, Davis K, Bailey JM. Multidisciplinary coordination of care for children with esophageal atresia and tracheoesophageal fistula. J Child Health Care 2023:13674935231174503. [PMID: 37224564 DOI: 10.1177/13674935231174503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Esophageal Atresia/Tracheoesophageal Atresia (EA/TEF) is a multisystem congenital anomaly. Historically, children with EA/TEF lack coordinated care. A multidisciplinary clinic was established in 2005 to provide coordinated care and improve access to outpatient care. This single-center retrospective cohort study was conducted to describe our cohort of patients with EA/TEF born between March 2005 and March 2011, assess coordination of care, and to compare outcomes of children in the multidisciplinary clinic to the previous cohort without a multi-disciplinary clinic. A chart review identified demographics, hospitalizations, emergency visits, clinic visits, and coordination of outpatient care. Twenty-seven patients were included; 75.9% had a C-type EA/TEF. Clinics provided multidisciplinary care and compliance with the visit schedule was high with a median of 100% (IQR 50). Compared to the earlier cohort, the new cohort (N = 27) had fewer hospital admissions and LOS was reduced significantly in the first 2 years of life. Multidisciplinary care clinics for medically complex children can improve coordination of visits with multiple health care providers and may contribute to reduced use of acute care services.
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Affiliation(s)
- Jody M Platt
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Alberto Nettel-Aguirre
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Candice L Bjornson
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Kathryn Davis
- Alberta Children's Hospital, Alberta Health Services, University of Calgary, Calgary, AB, Canada
| | - Ja Michelle Bailey
- Department of Pediatrics, Cummings School of Medicine, University of Calgary, Calgary, AB, Canada
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Zarfati A, Tambucci R, Bagolan P, Conforti A. Isoperistaltic gastric tube for long gap esophageal atresia (LGEA) in newborn, infants, and toddlers: a case-control study from a tertiary center. Front Pediatr 2023; 11:1194928. [PMID: 37260794 PMCID: PMC10228820 DOI: 10.3389/fped.2023.1194928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/03/2023] [Indexed: 06/02/2023] Open
Abstract
Background Limited evidence exists about outcomes after gastric tube formation as "rescue" technique to avoid esophageal replacement in long gap esophageal atresia (LGEA). The last ERNICA Consensus Conference on the Management of LGEA has placed the techniques of gastric tubulization among the priorities for future research. Aims Evaluate personal experience with Isoperistaltic Gastric Tube (IGT) and compare its outcomes with other more popular techniques for LGEA. Methods A case-control study has been conducted. A retrospective monocentric analysis of LGEA patients (period: 2010-19) has been conducted in all consecutive IGT patients and each of these has been type matched with two cases of LGEA treated with other techniques. The follow-up (FU) considered was 24-months. Results IGT and controls showed no statistically significant differences regarding preoperative variables like sex, gestational age, birth weight, syndromes, and EA type. However, IGT patients had a significantly longer esophageal GAP under boost pressure (4.5 vertebral bodies vs. 3.6, p = 0.019) at time of surgery. The analysis showed no statistical difference among the two groups about perioperative outcomes, ICU, or overall postoperative stay. No differences have been shown between IGT and controls during the follow-up regarding GERD, esophagitis, fundoplication, dysphagia, vocal cord paralysis, stenosis, and dilatations, auxologic data, need for anastomosis revision, oral aversion, and death. Conclusions Isoperistaltic Gastric Tube is safe and effective even in LGEA patients with longer gaps, with good perioperative, post-operative and middle-term outcomes. This procedure may be considered as an alternative to avoid esophageal substitution when a primary anastomosis seems impossible for a residual gap after traction and growth techniques.
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Affiliation(s)
- Angelo Zarfati
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Neonatal Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Renato Tambucci
- Digestive Endoscopy and Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Pietro Bagolan
- Department of Systems Medicine, University of Rome “Tor Vergata”, Rome, Italy
- Neonatal Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Andrea Conforti
- Neonatal Surgery Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Mitchell TK, Hall NJ, Yardley I, Cole C, Hardy P, King A, Murray D, Nuthall E, Roehr C, Stanbury K, Williams R, Pearce J, Woolfall K. Mixed-methods feasibility study to inform a randomised controlled trial of proton pump inhibitors to reduce strictures following neonatal surgery for oesophageal atresia. BMJ Open 2023; 13:e066070. [PMID: 37080617 PMCID: PMC10124212 DOI: 10.1136/bmjopen-2022-066070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVES This mixed-methods feasibility study aimed to explore parents' and medical practitioners' views on the acceptability and design of a clinical trial to determine whether routine prophylactic proton pump inhibitors (PPI) reduce the incidence of anastomotic stricture in infants with oesophageal atresia (OA). DESIGN Semi-structured interviews with UK parents of an infant with OA and an online survey, telephone interviews and focus groups with clinicians. Data were analysed using reflexive thematic analysis and descriptive statistics. PARTICIPANTS AND SETTING We interviewed 18 parents of infants with OA. Fifty-one clinicians (49 surgeons, 2 neonatologists) from 20/25 (80%) units involved in OA repair completed an online survey and 10 took part in 1 of 2 focus groups. Interviews were conducted with two clinicians whose survey responses indicated they had concerns about the trial. OUTCOME MEASURES Parents and clinicians ranked the same top four outcomes ('Severity of anastomotic stricture', 'Incidence of anastomotic stricture', 'Need for treatment of reflux' and 'Presence of symptoms of reflux') as important to measure for the proposed trial. RESULTS All parents and most clinicians found the use, dose and duration of omeprazole as the intervention medication, and the placebo control, as acceptable. Parents stated they would hypothetically consent to their child's participation in the trial. Concerns of a few parents and clinicians about infants suffering with symptomatic reflux, and the impact of this for study retention, appeared to be alleviated through the symptomatic reflux treatment pathway. Hesitant clinician views appeared to change through discussion of parental support for the study and by highlighting existing research that questions current practice of PPI treatment. CONCLUSIONS Our findings indicate that parents and most clinicians view the proposed Treating Oesophageal Atresia with prophylactic proton pump inhibitors to prevent STricture (TOAST) trial to be feasible and acceptable so long as infants can be given PPI if clinicians deem it clinically necessary. This insight into parent and clinician views and concerns will inform pilot phase trial monitoring, staff training and the development of the trial protocol.
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Affiliation(s)
- Tracy Karen Mitchell
- Department of Public Health, Policy and Systems, Faculty of Health and Life Sciences, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Nigel J Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Iain Yardley
- Evelina Children's Hospital, Guy's & St. Thomas's NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King's College, London, UK
| | - Christina Cole
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Pollyanna Hardy
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Andy King
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - David Murray
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elizabeth Nuthall
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Charles Roehr
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kayleigh Stanbury
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Williams
- National Perinatal Epidemiology Unit, Clinical Trials Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Kerry Woolfall
- Department of Public Health, Policy and Systems, Faculty of Health and Life Sciences, Institute of Population Health, University of Liverpool, Liverpool, UK
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Haig-Ferguson A, Wallace V, Davis C. The lived experience of adults and parents: Transitioning from paediatric to adult health care with oesophageal atresia and tracheo-oesophageal fistula. J Clin Nurs 2023; 32:1433-1442. [PMID: 35460126 DOI: 10.1111/jocn.16333] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 02/26/2022] [Accepted: 03/23/2022] [Indexed: 12/20/2022]
Abstract
AIM AND OBJECTIVE To explore the experience of healthcare transition from paediatric to adult health care for adults born with oesophageal atresia and tracheo-oesophageal fistula (OA/TOF) and parents. BACKGROUND OA/TOF is a rare and chronic health condition that can require lifelong medical follow-up and management. There is evidence to suggest that transitioning from paediatric to adult health care can be problematic for people with rare and chronic conditions, including OA/TOF. The previous literature suggests that the experience of transitioning with a rare condition is more complex than transitioning with a common chronic condition. DESIGN The current study was a qualitative, cross-sectional, survey-based study. METHODS Data were collected through an online survey. Parents of children born with OA/TOF (n = 23) and adults born with OA/TOF (n = 16) were recruited through a UK-based OA/TOF patient charity. Data from six open-ended questions were analysed using a hybrid approach combining elements of inductive and deductive thematic analyses. Throughout the research process, the SRQR were followed. RESULTS Five themes were constructed during the analysis, reflecting the experience of parents and adults transitioning from paediatric to adult health care: thrown into the unknown; a cultural shift; stepping back and stepping up; 'no transition as such'; and living with uncertainty. CONCLUSIONS The findings suggested that a formalised, managed healthcare transition is not commonly experienced by people born with OA/TOF and parents. RELEVANCE TO CLINICAL PRACTICE We recommend a formalised healthcare transition process in OA/TOF, including preparation for transition and having a named key worker to manage the multidisciplinary transition process. The results also highlighted the need for adults born with OA/TOF to have access to a specialist health service with knowledge and understanding of issues related to OA/TOF.
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Affiliation(s)
| | - Vuokko Wallace
- Department of Clinical Psychology, University of Bath, Bath, UK
| | - Cara Davis
- Department of Clinical Psychology, University of Bath, Bath, UK
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Bourg A, Gottrand F, Parmentier B, Thomas J, Lehn A, Piolat C, Bonnard A, Sfeir R, Lienard J, Rousseau V, Pouzac M, Liard A, Buisson P, Haffreingue A, David L, Branchereau S, Carcauzon V, Kalfa N, Leclair MD, Lardy H, Irtan S, Varlet F, Gelas T, Potop D, Auger-Hunault M. Outcome of long gap esophageal atresia at 6 years: A prospective case control cohort study. J Pediatr Surg 2023; 58:747-755. [PMID: 35970676 DOI: 10.1016/j.jpedsurg.2022.07.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/07/2022] [Accepted: 07/26/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND DATA EA is the most frequent congenital esophageal malformation. Long gap EA remains a therapeutic challenge for pediatric surgeons. A case case-control prospective study from a multi-institutional national French data base was performed to assess the outcome, at age of 1 and 6 years, of long gap esophageal atresia (EA) compared with non-long gap EA/tracheo-esophageal fistula (TEF). The secondary aim was to assess whether initial treatment (delayed primary anastomosis of native esophagus vs. esophageal replacement) influenced mortality and morbidity at ages 1 and 6 years. METHODS A multicentric population-based prospective study was performed and included all patients who underwent EA surgery in France from January 1, 2008 to December 31, 2010. A comparative study was performed with non-long gap EA/TEF patients. Morbidity at birth, 1 year, and 6 years was assessed. RESULTS Thirty-one patients with long gap EA were compared with 62 non-long gap EA/TEF patients. At age 1 year, the long gap EA group had longer parenteral nutrition support and longer hospital stay and were significantly more likely to have complications both early post-operatively and before age 1 year compared with the non-long gap EA/TEF group. At 6 years, digestive complications were more frequent in long gap compared to non-long gap EA/TEF patients. Tracheomalacia was the only respiratory complication that differed between the groups. Spine deformation was less frequent in the long gap group. There were no differences between conservative and replacement groups at ages 1 and 6 years except feeding difficulties that were more common in the native esophagus group. CONCLUSIONS Long gap strongly influenced digestive morbidity at age 6 years.
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Affiliation(s)
- Agate Bourg
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France.
| | - Frédéric Gottrand
- Univ. Lille, CHU Lille, Reference center for rare esophageal diseases, Inserm U1286, F59000, Lille, France
| | - Benoit Parmentier
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Julie Thomas
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Anne Lehn
- Pediatric Surgery Unit, University Hospital of Strasbourg, 67200 Strasbourg, France
| | - Christian Piolat
- Pediatric Surgery Unit, University Hospital of Grenoble, 38700 Grenoble, France
| | - Arnaud Bonnard
- Pediatric Surgery Unit, Robert Debré Hospital APHP, 75019 Paris, France
| | - Rony Sfeir
- Pediatric Surgery Unit, University Hospital of Lille Jeanne de Flandre, 59000 Lille, France
| | - Julie Lienard
- Pediatric Surgery Unit, University Hospital of Nancy, 54035 Nancy, France
| | | | - Myriam Pouzac
- Pediatric Surgery Unit, Hospital of Orléans, 45100 Orléans, France
| | - Agnès Liard
- Pediatric Surgery Unit, University Hospital of Rouen, 76000 Rouen, France
| | - Philippe Buisson
- Pediatric Surgery Unit, University Hospital of Amiens-Picardie, 80054 Amiens, France
| | - Aurore Haffreingue
- Pediatric Surgery Unit, University Hospital of Caen Normandie, 14000 Caen, France
| | - Louis David
- Pediatric Surgery Unit, University Hospital of Dijon F.Mitterand, 21000 Dijon, France
| | - Sophie Branchereau
- Pediatric Surgery Unit, Bicetre Hospital APHP, 94270 Le Kremlin-Bicêtre, France
| | | | - Nicolas Kalfa
- Pediatric Surgery Unit, University Hospital of Montpellier, 34295 Montpellier, France
| | - Marc-David Leclair
- Pediatric Surgery Unit, University Hospital of Nantes Hotel Dieu, 44093 Nantes, France
| | - Hubert Lardy
- Pediatric Surgery Unit, University Hospital of Tours, 37000 Tours, France
| | - Sabine Irtan
- Pediatric Surgery Unit, Armand Trousseau Hospital APHP, 75012 Paris, France
| | - François Varlet
- Pediatric Surgery Unit, University Hospital of Saint-Etienne, 42055 Saint-Etienne Cedex 2
| | - Thomas Gelas
- Pediatric Surgery Unit, University Hospital of Lyon HCL Women Mother Children Hospital, 69500 Bron, France
| | - Diana Potop
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
| | - Marie Auger-Hunault
- Pediatric Surgery Unit, University Hospital Center of Poitiers, 86000 Poitiers, France
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Yasuda JL, Manfredi MA. Endoscopic Management of Congenital Esophageal Defects and Associated Comorbidities. Gastrointest Endosc Clin N Am 2023; 33:341-361. [PMID: 36948750 DOI: 10.1016/j.giec.2022.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
The endoscopist plays a critical role in the management of patients with congenital esophageal defects. This review focuses on esophageal atresia and congenital esophageal strictures and, in particular, the endoscopic management of comorbidities related to these conditions, including anastomotic strictures, tracheoesophageal fistulas, esophageal perforations, and esophagitis surveillance. Practical aspects of endoscopic techniques for stricture management are reviewed including dilation, intralesional steroid injection, stenting, and endoscopic incisional therapy. Endoscopic surveillance for mucosal pathology is essential in this population, as patients are at high risk of esophagitis and its late complications such as Barrett's esophagus.
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Affiliation(s)
- Jessica L Yasuda
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02115, USA
| | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, 3401 Civic Center Boulevard, Philadelphia, PA 19104, USA.
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Teunissen N, Brendel J, Eaton S, Hall N, Thursfield R, van Heurn ELW, Ure B, Wijnen R. Variability in the Reporting of Baseline Characteristics, Treatment, and Outcomes in Esophageal Atresia Publications: A Systematic Review. Eur J Pediatr Surg 2023; 33:129-137. [PMID: 36796427 DOI: 10.1055/s-0042-1758828] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
INTRODUCTION As survival rates of infants born with esophageal atresia (EA) have improved considerably, research interests are shifting from viability to morbidity and longer-term outcomes. This review aims to identify all parameters studied in recent EA research and determine variability in their reporting, utilization, and definition. MATERIALS AND METHODS Following PRISMA guidelines, we performed a systematic review of literature regarding the main EA care process, published between 2015 and 2021, combining the search term "esophageal atresia" with "morbidity," "mortality," "survival," "outcome," or "complication." Described outcomes were extracted from included publications, along with study and baseline characteristics. RESULTS From 209 publications that met the inclusion criteria, 731 studied parameters were extracted and categorized into patient characteristics (n = 128), treatment and care process characteristics (n = 338), and outcomes (n = 265). Ninety-two of these were reported in more than 5% of included publications. Most frequently reported characteristics were sex (85%), EA type (74%), and repair type (60%). Most frequently reported outcomes were anastomotic stricture (72%), anastomotic leakage (68%), and mortality (66%). CONCLUSION This study demonstrates considerable heterogeneity of studied parameters in EA research, emphasizing the need for standardized reporting to compare results of EA research. Additionally, the identified items may help develop an informed, evidence-based consensus on outcome measurement in esophageal atresia research and standardized data collection in registries or clinical audits, thereby enabling benchmarking and comparing care between centers, regions, and countries.
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Affiliation(s)
- Nadine Teunissen
- Department of Pediatric Surgery and Pediatric Intensive Care Unit, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Dutch Institute for Clinical Auditing, European Pediatric Surgical Audit, Leiden, the Netherlands
| | - Julia Brendel
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Simon Eaton
- Department of Pediatric Surgery and Pediatric Intensive Care Unit, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
- Developmental Biology and Cancer Research and Teaching Programme, UCL Great Ormond Street Institute of Child Health, London, United Kingdom of Great Britain and Northern Ireland
| | - Nigel Hall
- University Surgery Unit, Faculty of Medicine, University of Southampton, Southampton, United Kingdom of Great Britain and Northern Ireland
| | - Rebecca Thursfield
- Department of Pediatric Respiratory Medicine, Alder Hey Children's NHS Foundation Trust, Liverpool, United Kingdom of Great Britain and Northern Ireland
| | - Ernest L W van Heurn
- Department of Pediatric Surgery, Emma's Children's Hospital, Amsterdam UMC, Amsterdam, the Netherlands
- Amsterdam Reproduction and Development Research Institute, Amsterdam, the Netherlands
| | - Benno Ure
- Department of Pediatric Surgery, Hannover Medical School, Hannover, Niedersachsen, Germany
| | - Rene Wijnen
- Department of Pediatric Surgery and Pediatric Intensive Care Unit, Erasmus MC Sophia Children's Hospital, Rotterdam, the Netherlands
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König TT, Frankenbach ML, Gianicolo E, Holler AS, von Sochaczewski CO, Wessel L, Widenmann A, Klos L, Kolb S, Siaplaouras J, Niessner C. 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. Eur J Pediatr 2023:10.1007/s00431-023-04923-3. [PMID: 36976316 PMCID: PMC10257632 DOI: 10.1007/s00431-023-04923-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 02/28/2023] [Accepted: 03/03/2023] [Indexed: 03/29/2023]
Abstract
Oesophageal atresia (EA) is associated with life-long gastrointestinal and respiratory morbidity and other associated malformations. The aim of this study is to compare physical activity (PA) levels of children and adolescents with and without EA. A validated questionnaire (MoMo-PAQ) was used to evaluate PA in EA patients EA (4-17 years), who were randomly matched for gender and age (1:5) with a representative sample of the Motorik-Modul Longitudinal Study (n = 6233). Sports activity per week (sports index) and minutes of moderate to vigorous physical activity per week (MVPA minutes) were calculated. Correlations between PA and medical factors were analysed. In total, 104 patients and 520 controls were included. Children with EA were significantly less active at higher intensities (mean MPVA minutes 462; 95% confidence interval (CI): 370-554) compared to controls (626; 95% CI: 576-676), although there was no statistically significant difference in the sports index (187; 95% CI: 156-220 versus 220; 95% CI: 203-237). A lower mean weight-for-age and height-for-age, additional urogenital (r = - 0.20, p = 0.04) or anorectal malformation (r = - 0.24, p = 0.01) were associated with fewer MVPA minutes. For other medical factors (prematurity, type of repair, congenital heart disease, skeletal malformation or symptom load), no statistically significant association with PA was found. Conclusion: EA patients participated in PA at a similar level but lower intensities compared to the reference cohort. PA in EA patients was largely independent of medical factors. TRIAL REGISTRATION German Clinical Trials Register (ID: DRKS00025276) on September 6, 2021. WHAT IS KNOWN • Oesophageal atresia is associated with a low body weight and height, delayed development of motor skills and impaired lung function and exercise capacity. WHAT IS NEW • Patients with oesophageal atresia have a similar amount of sports activity per week but engage significantly less in moderate to vigorous physical activities compared to peers. • Physical activity was associated with weight-for-age and height-for-age, but largely independent of symptom load and other medical factors.
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Affiliation(s)
- Tatjana Tamara König
- Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany.
| | - Maria-Luisa Frankenbach
- Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University Mainz, Langenbeckstr. 1, Mainz, 55131, Germany
| | - Emilio Gianicolo
- Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Universitätsmedizin, Johannes Gutenberg-University Mainz, Mainz, Germany
- Institute of Clinical Physiology, National Research Council, Lecce, Italy
| | - Anne-Sophie Holler
- Department of Pediatric Surgery, Dr. von Hauner Children's Hospital, University Hospital, LMU Munich, Munich, Germany
| | - Christina Oetzmann von Sochaczewski
- Sektion Kinderchirurgie, Klinik und Poliklinik Für Allgemein-, Viszeral-, Thorax- Und Gefäßchirurgie, Universitätsklinikum Bonn, Bonn, Germany
| | - Lucas Wessel
- Pediatric Surgery, University Medical Centre Mannheim, Mannheim, Germany
| | - Anke Widenmann
- Patient Organisation for Esophageal Diseases KEKS e.V., Stuttgart, Germany
| | - Leon Klos
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
| | - Simon Kolb
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
| | | | - Claudia Niessner
- Institute of Sports and Sports Science (IfSS), Karlsruhe Institute of Technology, Karlsruhe, Germany
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Systematic review of long term follow-up and transitional care in adolescents and adults with esophageal atresia - why is transitional care mandatory? Eur J Pediatr 2023; 182:2057-2066. [PMID: 36905437 PMCID: PMC10175361 DOI: 10.1007/s00431-023-04893-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/07/2023] [Accepted: 02/17/2023] [Indexed: 03/12/2023]
Abstract
PURPOSE to review recent literature concerning long-term health issues and transitional care in esophageal atresia (EA) patients. PubMed, Scopus, Embase and Web of Science databases were screened for studies regarding EA patients aged more than or equal to 11 years, published between August 2014 and June 2022. Sixteen studies involving 830 patients were analyzed. Mean age was 27.4 years (range 11-63). EA subtype distribution was: type C (48.8%), A (9.5%), D (1.9%), E (0.5%) and B (0.2%). 55% underwent primary repair, 34.3% delayed repair, 10.5% esophageal substitution. Mean follow-up was 27.2 years (range 11-63). Long-term sequelae were: gastro-esophageal reflux (41.4%), dysphagia (27.6%), esophagitis (12.4%), Barrett esophagus (8.1%), anastomotic stricture (4.8%); persistent cough (8.7%), recurrent infections (4.3%) and chronic respiratory diseases (5.5%). Musculo-skeletal deformities were present in 36 out of 74 reported cases. Reduced weight and height were detected in 13.3% and 6% cases, respectively. Impaired quality of life was reported in 9% of patients; 9.6% had diagnosis or raised risk of mental disorders. 10.3% of adult patients had no care provider. Meta-analysis was conducted on 816 patients. Estimated prevalences are: GERD 42.4%, dysphagia 57.8%, Barrett esophagus 12.4%, respiratory diseases 33.3%, neurological sequelae 11.7%, underweight 19.6%. Heterogeneity was substantial (> 50%). Conclusion: EA patients must continue follow-up beyond childhood, with a defined transitional-care path by a highly specialized multidisciplinary team due to the multiple long-term sequelae. WHAT IS KNOWN • Survival rates of esophageal atresia patients is now more than 90% thanks to the improvements in surgical techniques and intensive care, therefore patients' needs throughout adolescence and adulthood must be taken into account. WHAT IS NEW • This review, by summarizing recent literature concerning long term sequelae of esophageal atresia, may contribute to raise awareness on the importance of defining standardized protocols of transitional and adulthood care for esophageal atresia patients.
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Feeding and Swallowing Characteristics of Children With Esophageal Atresia and Tracheoesophageal Fistula. J Pediatr Gastroenterol Nutr 2023; 76:288-294. [PMID: 36728731 DOI: 10.1097/mpg.0000000000003697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to characterize feeding/swallowing difficulties in children with esophageal atresia and/or tracheoesophageal fistula (EA/TEF) and evaluate associations among feeding difficulties, pharyngeal dysphagia (PD), and other aerodigestive evaluation findings. METHODS This was a retrospective cohort study of feeding/swallowing characteristics of 44 patients with EA/TEF treated in the aerodigestive program of a single academic medical institution from 2010 to 2015. Demographics, comorbidities, presence and characteristics of feeding/swallowing difficulties, and results of relevant diagnostic tests [videofluoroscopic swallow studies (VFSS), clinical feeding evaluations (CFEs), chest computerized tomography (CT) scans, pulmonary bronchoscopies, and upper GI (UGI)/esophagrams] were reviewed. RESULTS Fifty percent of the cohort had PD and 88.6% had feeding difficulties. Across 118 encounters (87 VFSS and 31 CFEs), feeding difficulties suggestive of esophageal dysphagia were most frequently seen in children over 48 months and feeding difficulties suggestive of developmental feeding problems were most frequently seen in children from 24 to 48 months. Abnormal findings were present in 59.8% of VFSS, with aspiration (34.5%) and pharyngeal residue (26.4%) the most frequently observed signs of dysphagia. Abnormal UGI/esophagram findings were not associated with significantly increased risk of feeding difficulties during visits within 3 months (risk ratio, RR = 1.33). Presence of dysphagia was associated with increased risk for some abnormal CT findings (RR= 3.0 for airspace and 3.0 for bronchiectasis). CONCLUSIONS Feeding/swallowing difficulties are common in EA/TEF, and types of feeding difficulties vary by patient age. The presence of abnormal findings on UGI/esophagram did not increase the risk of feeding complaints; however, the presence of dysphagia increased the risk of abnormal chest CT.
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Yasuda JL, Taslitsky GN, Staffa SJ, Ngo PD, Meisner J, Mohammed S, Hamilton T, Zendejas B, Manfredi MA. Predictors of enteral tube dependence in pediatric esophageal atresia. Dis Esophagus 2023; 36:6692452. [PMID: 36065605 DOI: 10.1093/dote/doac060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 12/11/2022]
Abstract
Children with esophageal atresia (EA) may require enteral tube feedings in infancy and a subset experience ongoing feeding difficulties and enteral tube dependence. Predictors of enteral tube dependence have never been systematically explored in this population. We hypothesized that enteral tube dependence is multifactorial in nature, with likely important contributions from anastomotic stricture. Cross-sectional clinical, feeding, and endoscopic data were extracted from a prospectively collected database of endoscopies performed in EA patients between August 2019 and August 2021 at an international referral center for EA management. Clinical factors known or hypothesized to contribute to esophageal dysphagia, oropharyngeal dysphagia, or other difficulties in meeting caloric needs were incorporated into regression models for statistical analysis. Significant predictors of enteral tube dependence were statistically identified. Three-hundred thirty children with EA were eligible for analysis. Ninety-seven were dependent on enteral tube feeds. Younger age, lower weight Z scores, long gap atresia, neurodevelopmental risk factor(s), significant cardiac disease, vocal fold movement impairment, and smaller esophageal anastomotic diameter were significantly associated with enteral tube dependence in univariate analyses; only weight Z scores, vocal fold movement impairment, and anastomotic diameter retained significance in a multivariable logistic regression model. In the current study, anastomotic stricture is the only potentially modifiable significant predictor of enteral tube dependence that is identified.
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Affiliation(s)
- Jessica L Yasuda
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Gabriela N Taslitsky
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care, and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Peter D Ngo
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
| | - Jay Meisner
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Somala Mohammed
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | - Thomas Hamilton
- Department of Surgery, Boston Children's Hospital, Boston, MA, USA
| | | | - Michael A Manfredi
- Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA, USA
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Hamilton-Hall MN, Jungbauer D, Finck C, Middlesworth W, Zendejas B, Alaish SM, Griggs CL, Russell RT, Shieh HF, Scholz S, Kunisaki SM, Feng C, Danko ME, DeFazio JR, Smithers CJ, Zamora IJ, Knod JL. Esophageal Surveillance Practices in Esophageal Atresia Patients: A Survey by the Eastern Pediatric Surgery Network. J Pediatr Surg 2023; 58:1213-1218. [PMID: 36931942 DOI: 10.1016/j.jpedsurg.2023.02.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 02/10/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION Endoscopic surveillance guidelines for patients with repaired esophageal atresia (EA) rely primarily on expert opinion. Prior to embarking on a prospective EA surveillance registry, we sought to understand EA surveillance practices within the Eastern Pediatric Surgery Network (EPSN). METHODS An anonymous, 23-question Qualtrics survey was emailed to 181 physicians (surgeons and gastroenterologists) at 19 member institutions. Likert scale questions gauged agreement with international EA surveillance guideline-derived statements. Multiple-choice questions assessed individual and institutional practices. RESULTS The response rate was 77%. Most respondents (80%) strongly agree or agree that EA surveillance endoscopy should follow a set schedule, while only 36% claimed to perform routine upper GI endoscopy regardless of symptoms. Many institutions (77%) have an aerodigestive clinic, even if some lack a multi-disciplinary EA team. Most physicians (72%) expressed strong interest in helping develop evidence-based guidelines. CONCLUSIONS Our survey reveals physician agreement with current guidelines but weak adherence. Surveillance methods vary greatly, underscoring the lack of evidence-based data to guide EA care. Aerodigestive clinics may help implement surveillance schedules. Respondents support evidence-based protocols, which bodes well for care standardization. Results will inform the first multi-institutional EA databases in the United States (US), which will be essential for evidence-based care. LEVEL OF EVIDENCE This is a prognosis study with level 4 evidence.
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Affiliation(s)
- Malcolm N Hamilton-Hall
- MD/MPH Dual-Degree Program, University of Connecticut School of Medicine, UConn John Dempsey Hospital, 100 Hospital Drive, Farmington, CT, 06030, United States
| | - Dana Jungbauer
- Division of Research Operations and Development, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, United States
| | - Christine Finck
- Division of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, United States
| | - William Middlesworth
- Division of Pediatric Surgery, Columbia Irving Medical Center, 622 W 168th St, New York, NY, 10032, United States; Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN, 37232, United States
| | - Benjamin Zendejas
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, 02115, United States
| | - Samuel M Alaish
- Department of Surgery, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States
| | - Cornelia L Griggs
- Division of Pediatric Surgery, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02114, USA; Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States
| | - Robert T Russell
- Division of Pediatric Surgery, Children's of Alabama, 1600 7th Avenue South, Birmingham, AL, 35233, United States
| | - Hester F Shieh
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, 501 6th Ave S, St. Petersburg, FL, 33701, United States
| | - Stefan Scholz
- Division of Pediatric General and Thoracic Surgery, UPMC Children's Hospital of Pittsburgh, One Children's Hospital Drive, 4401 Penn Ave, Pittsburgh, PA, 15224, United States
| | - Shaun M Kunisaki
- Department of Surgery, Johns Hopkins University School of Medicine, 733 N Broadway, Baltimore, MD, 21205, United States
| | - Christina Feng
- Division of Pediatric Colorectal & Pelvic Reconstruction, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, United States
| | - Melissa E Danko
- Department of Pediatric Surgery, Monroe Carell Jr. Children's Hospital at Vanderbilt, 2200 Children's Way, Nashville, TN, 37232, United States
| | - Jennifer R DeFazio
- Division of Pediatric Surgery, NewYork-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, New York, NY, 10032, United States
| | - Charles J Smithers
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, 501 6th Ave S, St. Petersburg, FL, 33701, United States
| | - Irving J Zamora
- Division of Pediatric Colorectal & Pelvic Reconstruction, Children's National Hospital, 111 Michigan Ave NW, Washington, DC, 20010, United States
| | - J Leslie Knod
- Division of Pediatric Surgery, Connecticut Children's Medical Center, 282 Washington Street, Hartford, CT, 06106, United States.
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Newland N, Snajdauf J, Kokesova A, Styblova J, Hradsky O, Meusel I, Kucerova B, Kyncl M, Simsova M, Mixa V, Rygl M. Anastomotic stricture prediction in patients with esophageal atresia with distal fistula. Pediatr Surg Int 2023; 39:136. [PMID: 36811679 PMCID: PMC9947071 DOI: 10.1007/s00383-023-05423-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To investigate potential early risk factors for anastomotic stricture formation and assess the predictive role of post-operative esophagrams. METHODS A retrospective study of patients with esophageal atresia with distal fistula (EA/TEF) operated between 2011 and 2020. Fourteen predictive factors were tested for stricture development. Esophagrams were used to calculate early (SI1) and late (SI2) stricture index (SI = anastomosis diameter/upper pouch diameter). RESULTS Of 185 patients operated for EA/TEF in the 10-year period, 169 patients met the inclusion criteria. Primary anastomosis was performed in 130 patients and delayed anastomosis in 39 patients. Stricture formed in 55 patients (33%) within 1 year from anastomosis. Four risk factors showed strong association with stricture formation in unadjusted models: long gap (p = 0.007), delayed anastomosis (p = 0.042), SI1 (p = 0.013) and SI2 (p < 0.001). A multivariate analysis showed SI1 as significantly predictive of stricture formation (p = 0.035). Cut-off values using a receiver operating characteristic (ROC) curve were 0.275 for SI1 and 0.390 for SI2. The area under the ROC curve demonstrated increasing predictiveness from SI1 (AUC 0.641) to SI2 (AUC 0.877). CONCLUSIONS This study identified an association between long gap and delayed anastomosis with stricture formation. Early and late stricture indices were predictive of stricture formation.
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Affiliation(s)
- Natalia Newland
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic.
| | - Jiri Snajdauf
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Alena Kokesova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Jitka Styblova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Ondrej Hradsky
- Department of Pediatric Gastroenterology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Isabel Meusel
- Second Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Barbora Kucerova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Martin Kyncl
- Department of Radiology, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Magdalena Simsova
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Vladimir Mixa
- Department of Anesthesiology and ICM, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
| | - Michal Rygl
- Department of Pediatric Surgery, 2nd Faculty of Medicine, Charles University in Prague and Motol University Hospital, Prague, Czech Republic
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König TT, Stefanescu MC, Wildermuth M, Frankenbach LM, Muensterer OJ, Gianicolo E. Sex-specific percentiles for bodyweight and height in children born with esophageal atresia: a registry-based analysis 2001-2021. BMC Pediatr 2023; 23:27. [PMID: 36650449 PMCID: PMC9847123 DOI: 10.1186/s12887-023-03842-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 01/09/2023] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Esophageal atresia (EA) is a rare malformation with a wide range of co-morbidity and associated malformations impairing weight gain and growth. The aim of this study was to calculate specific percentiles for body weight and height for children born with esophageal atresia according to sex from birth to the age of 6 years, accounting for prematurity and presence of congenital heart disease (CHD). METHODS Data was extracted from an anonymized voluntary national registry for patients born with esophageal atresia between 2001 and 2021, from birth until the age of six years. Missing values were imputed using a multiple imputation approach. In premature infants, chronological age was corrected for gestational week until the age of one year. The impact of sex and additional congenital heart disease on weight gain and growth was analysed using quartile regression models. RESULTS In total, 1812 examinations of 485 patients were considered and 1232 examinations of 301 patients were finally included. Most data was available for children at birth and during the first year of life. Body weight was imputed for 3.3% and height for 12.5% of examinations. The mean body weight-for-age and length-for-age at birth according to gestational age was lower in EA patients and median body weight developed along the tenth percentile compared to the general population. Median height-for-age was at the 50th percentile during the first months of life, before crossing to lower percentiles before the age of one year. CHD had an additional negative impact on growth and weight gain, especially during the first year of life. CONCLUSIONS Children with EA had a reduced bodyweight and -height compared to the general population. Therefore, specific percentile curves are helpful to evaluate growth and development. Especially during the first year of life, particular attention is necessary and complications leading to a reduced calorie intake should be treated without delay to promote timely development and growth. Cardiac co-morbidities may further compromise weight gain in these patients, implying that such patients should be under even closer surveillance.
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Affiliation(s)
- Tatjana Tamara König
- grid.5802.f0000 0001 1941 7111Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University, 55131 Mainz, Germany
| | - Maria-Christina Stefanescu
- grid.5802.f0000 0001 1941 7111Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University, 55131 Mainz, Germany
| | - Melanie Wildermuth
- Kinder und Erwachsene mit kranker Speiseröhre, KEKS e.V., Stuttgart, Germany
| | - Luisa Maria Frankenbach
- grid.5802.f0000 0001 1941 7111Department of Pediatric Surgery, Universitätsmedizin, Johannes Gutenberg-University, 55131 Mainz, Germany
| | - Oliver J. Muensterer
- grid.5252.00000 0004 1936 973XDepartment of Pediatric Surgery, Dr. von Haunersches Kinderspital, Ludwig Maximilian-University Munich, Munich, Germany
| | - Emilio Gianicolo
- grid.5802.f0000 0001 1941 7111Institute of Medical Biostatistics, Epidemiology and Informatics (IMBEI), Universitätsmedizin, Johannes Gutenberg-University, Mainz, Germany ,grid.5326.20000 0001 1940 4177Institute of Clinical Physiology, National Research Council, Lecce, Italy
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47
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Locci C, Cuzzolin L, Cheri G, Saderi L, Sotgiu G, Antonucci R. Clinical Use of Gastric Antisecretory Drugs in Hospitalized Pediatric Patients. J Clin Med 2023; 12:jcm12010368. [PMID: 36615168 PMCID: PMC9821178 DOI: 10.3390/jcm12010368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 12/27/2022] [Accepted: 12/29/2022] [Indexed: 01/05/2023] Open
Abstract
Antisecretory drugs are frequently used in the treatment of pediatric gastrointestinal disorders. This study was aimed to assess the prescribing patterns and the safety of ranitidine and proton pump inhibitors (PPIs) in a cohort of Italian pediatric patients. Children aged >1 month to <16 years that were admitted to our Pediatric Clinic between 2016 and 2018 were enrolled in this retrospective observational study. All data were obtained from medical records and a parent telephone questionnaire. The exclusion criteria included the use of antisecretory therapy at hospital admission, failure to collect the relevant clinical data, and failure to administer the questionnaire. This study included 461 subjects, who were divided into four age groups: <2 years, 2−5 years, 6−11 years, and ≥12 years. Ranitidine was prescribed in 396 (85.9%) patients, mainly for the acute treatment of gastrointestinal symptoms, and a PPI was given to 65 (14.1%) children to treat gastroesophageal reflux disease, gastritis/ulcer, or for gastroprotection. During the study period, the percentage of patients treated with ranitidine progressively increased, except in the 2−5-year age group. We observed eighty-seven adverse drug reactions (ADRs), 61 of which occurred in the ranitidine group and 26 in the PPI group. The most common ADR was constipation (n = 35), which occurred more frequently in children treated with PPIs and in the 6−11-year age group. Ranitidine was the most used antisecretory drug in all the age groups, especially for acute treatment. Conversely, PPIs were the drugs of choice for prolonged treatments. Further research should be focused on developing an effective and safer alternative to ranitidine.
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Affiliation(s)
- Cristian Locci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Laura Cuzzolin
- Department of Diagnostics & Public Health, Section of Pharmacology, University of Verona, 37134 Verona, Italy
| | - Gianluca Cheri
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Laura Saderi
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Giovanni Sotgiu
- Clinical Epidemiology and Medical Statistics Unit, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
| | - Roberto Antonucci
- Pediatric Clinic, Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Correspondence:
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48
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Swallowing-related quality of life in children with oesophageal atresia: a national cohort study. Eur J Pediatr 2023; 182:275-283. [PMID: 36331620 PMCID: PMC9829586 DOI: 10.1007/s00431-022-04677-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Revised: 10/21/2022] [Accepted: 10/23/2022] [Indexed: 11/06/2022]
Abstract
UNLABELLED Swallowing and feeding disorders are a major concern for children with oesophageal atresia (OA) after primary or staged OA repair. Primary OA repair is associated with higher rates of short-term complications in preterm infants with very low birth weight (VLBW) or extreme low birth weight (ELBW). On the other hand, primary repair may have the benefit of early commencement of oral feedings. We hypothesize that also in the medium-term, swallowing-related quality of life is better after primary oesophageal repair. We conducted a prospective cross-sectional study on swallowing quality in a national cohort of former VLBW and ELBW children with OA, using the structured paediatric swallowing quality of life (pedSWAL-QOL) questionnaire. Results were correlated with surgical approach and baseline clinical data. Principal component analysis of pedSWAL-QOL domains was performed. In total, 44 complete data sets of 78 children were available. The mean age of children was 8.5 years (SD = 7.4), and 23 children (52%) had primary OA repair. The overall median pedSWAL-QOL score was 2 (IQR = 0-3), representing a high swallowing-related quality of life, independent of surgical technique (p = 0.086). Children with a history of intracranial haemorrhage (ICH) (p = 0.002) and those with VACTERL association (p = 0.008) had significantly decreased enjoyment with eating. In addition, children with VACTERL association had problems to find suitable foods (p = 0.04). CONCLUSION In this national cohort of VLBW and ELBW preterm-born children with OA, swallowing-related quality of life is good, mostly independent of initial surgery. Children with OA and ICH or VACTERL association may require more intense support with feeding. WHAT IS KNOWN • Dysphagia, resembling feeding and swallowing disorders, is common in children and adults with repaired oesophageal atresia. Nevertheless, dysphagia in children with oesophageal atresia decreases with age. • Parents of younger children suffer from increased anxiety and fear regarding eating and swallowing abilities of their children. WHAT IS NEW • Swallowing-related quality of life in former preterm children with oesophageal atresia is good, independent of initial surgical approach (primary vs. staged repair), even in very low birth weight or extreme low birth weight infants. • Children suffering from VACTERL association or intracranial haemorrhage show decreased enjoyment with eating.
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49
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Management of Adults With Esophageal Atresia. Clin Gastroenterol Hepatol 2023; 21:15-25. [PMID: 35952943 DOI: 10.1016/j.cgh.2022.07.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 07/26/2022] [Accepted: 07/27/2022] [Indexed: 02/07/2023]
Abstract
Esophageal atresia (EA) with or without trachea-esophageal fistula is relatively common congenital malformation with most patients living into adulthood. As a result, care of the adult patient with EA is becoming more common. Although surgical repair has changed EA from a fatal to a livable condition, the residual effects of the anomaly may lead to a lifetime of complications. These include effects related to the underlying deformity such as atonicity of the esophageal segment, fistula recurrence, and esophageal cancer to complications of the surgery including anastomotic stricture, gastroesophageal reflux, and coping with an organ transposition. This review discusses the occurrence and management of these conditions in adulthood and the role of an effective transition from pediatric to adult care to optimize adult care treatment.
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50
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Ten Kate CA, Teunissen NM, van Rosmalen J, Kamphuis LS, van Wijk MP, Joosten M, van Tuyll van Serooskerken ES, Wijnen R, IJsselstijn H, Rietman AB, Spaander MCW. Development and validation of a condition-specific quality of life instrument for adults with esophageal atresia: the SQEA questionnaire. Dis Esophagus 2022; 36:6957244. [PMID: 36562092 DOI: 10.1093/dote/doac088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 11/01/2022] [Indexed: 12/24/2022]
Abstract
The importance of multidisciplinary long-term follow-up for adults born with esophageal atresia (EA) is increasingly recognized. Hence, a valid, condition-specific instrument to measure health-related quality of life (HRQoL) becomes imperative. This study aimed to develop and validate such an instrument for adults with EA. The Specific Quality of life in Esophageal atresia Adults (SQEA) questionnaire was developed through focus group-based item generation, pilot testing, item reduction and a multicenter, nationwide field test to evaluate the feasibility, reliability (internal and retest) and validity (structural, construct, criterion and convergent), in compliance with the consensus-based standards for the selection of health measurement instruments guidelines. After pilot testing (n = 42), items were reduced from 144 to 36 questions. After field testing (n = 447), three items were discarded based on item-response theory results. The final SQEA questionnaire (33 items) forms a unidimensional scale generating an unweighted total score. Feasibility, internal reliability (Cronbach's alpha 0.94) and test-retest agreement (intra-class coefficient 0.92) were good. Construct validity was discriminative for esophageal replacement (P < 0.001), dysphagia (P < 0.001) and airway obstruction (P = 0.029). Criterion validity showed a good correlation with dysphagia (area under the receiver operating characteristic 0.736). SQEA scores correlated well with other validated disease-specific HRQoL scales such as the GIQLI and SGRQ, but poorly with the more generic RAND-36. Overall, this first condition-specific instrument for EA adults showed satisfactory feasibility, reliability and validity. Additionally, it shows discriminative ability to detect disease burden. Therefore, the SQEA questionnaire is both a valid instrument to assess the HRQoL in EA adults and an interesting signaling tool, enabling clinicians to recognize more severely affected patients.
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Affiliation(s)
- Chantal A Ten Kate
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Nadine M Teunissen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus University Medical Centre, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Lieke S Kamphuis
- Department of Pulmonology, Erasmus University Medical Centre, Rotterdam, The Netherlands
| | - Michiel P van Wijk
- Department of Pediatric Gastroenterology and Nutrition, Amsterdam University Medical Centers-Emma Children's Hospital, Amsterdam, The Netherlands
| | - Maja Joosten
- Department of Pediatric Surgery, Radboud University Medical Center-Amalia Children's Hospital, Nijmegen, The Netherlands
| | | | - René Wijnen
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Hanneke IJsselstijn
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - André B Rietman
- Department of Pediatric Surgery and Intensive Care Children, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus University Medical Centre-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Manon C W Spaander
- Department of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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