BAPS paperThe cumulative incidence of significant gastrooesophageal reflux in patients with oesophageal atresia with a distal fistula—a systematic clinical, pH-metric, and endoscopic follow-up study
Section snippets
Patients and methods
Sixty-one consecutive patients who underwent primary repair (PR) for OADF during the period from 1989 to 2004 were included in the study. All patients had survived at least one year with their native oesophagus. These patients were grouped according to the Spitz classification, as follows: type I (n = 47, 77%), type II (n = 12, 20%), and type III (n = 2, 3%). The incidence of heart disease, tracheomalacia, gastric outlet obstruction, and other significant congenital anomalies are shown in Table
Results
The median length of the patient follow-up was 5 (range,1-10) years. The number of patients available for assessment after OADF repair was 61 at six months, 61 at one year, 52 at 3 years, 43 at 5 years and 27 at 10 years. During the follow up, sGER was detected in a total of 28 (45.9%) of 61 patients. Eighteen patients (29.5% of the total of 61 and 64.3% of 28 with sGER) underwent ARS. Ten patients underwent ARS under 6 months of age, 2 between 6 months to 1 year, 5 between 1 and 3 years, and
Discussion
Gastrooesophageal reflux is a significant long-term sequel of OADF. The reported incidence of OADF associated GER varies depending whether the diagnostic criteria are based on symptoms, radiological findings, pH-metry, or endoscopy, from 35% to 60% [1], [6]. The 46% overall incidence of GER detected in the present study falls between these percentages. The portion of our patients with sGER to whom ARS was performed during the 10-year follow-up period was high (64%), but ARS rates, varying from
Q&A
- Höllwarth, Graz, Austria
Thank you very much for presenting your very interesting data. I must confess that I am a little bit doubtful in regard to the change in incidence of gastro-oesophageal reflux between the infancy and later age. pH Monitoring alone is heavily underestimating the real amount of reflux in children mainly fed with milk because milk buffers gastric acid for quite a long time. Especially in patients with oesophageal atresia, motility not only of the oesophagus but also of the
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Presented at the British Association of Paediatric Surgeons 53rd Annual International Congress, Stockholm, Sweden, July 18-22, 2006.