Longitudinal Follow-up of Bronchial Inflammation, Respiratory Symptoms, and Pulmonary Function in Adolescents after Repair of Esophageal Atresia with Tracheoesophageal Fistula

Malmström, Kristiina; Lohi, Jouko; Lindahl, Harry; Pelkonen, Anna; Kajosaari, Merja; Sarna, Seppo; Malmberg, L. Pekka; Mäkelä, Mika J.

doi:10.1016/j.jpeds.2008.03.034

« Previous Next »The Journal of Pediatrics
Volume 153, Issue 3 , Pages 396-401.e1, September 2008

Longitudinal Follow-up of Bronchial Inflammation, Respiratory Symptoms, and Pulmonary Function in Adolescents after Repair of Esophageal Atresia with Tracheoesophageal Fistula

Kristiina Malmström, MD, PhD
- From the Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland
- Reprint requests: Kristiina Malmström, MD, PhD, Department of Allergy, Helsinki University Central Hospital, PO Box 160, FI-00029 Helsinki, Finland
Jouko Lohi, MD, PhD
- Department of Pathology, Helsinki University Central Hospital, Helsinki, Finland
Harry Lindahl, MD, PhD
- Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
Anna Pelkonen, MD, PhD
- From the Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland
Merja Kajosaari, MD, PhD
- Hospital for Children and Adolescents, Helsinki University Central Hospital, Helsinki, Finland
Seppo Sarna, MD, PhD
- Department of Public Health, University of Helsinki, Finland
L. Pekka Malmberg, MD, PhD
- From the Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland
Mika J. Mäkelä, MD, PhD
- From the Department of Allergy, Helsinki University Central Hospital, Helsinki, Finland

Received 23 November 2007; received in revised form 15 January 2008; accepted 19 March 2008. published online 13 May 2008.

Objective

To characterize symptoms, pulmonary function tests (PFT) and bronchial responsiveness (BR) in adolescents after repaired esophageal atresia with tracheoesophageal fistula and correlate these with endobronchial biopsy findings.

Study design

After a primary operation, 31 patients underwent endoscopies and bronchoscopies at the age of <3, 3 to 7, and >7 years. A questionnaire on respiratory and esophageal symptoms was sent to patients at a mean age of 13.7 years (range, 9.7-19.4). The questionnaire was completed by 27 of 31 patients (87%), and 25 of the 31 patients (81%) underwent clinical examination and pulmonary functioning tests. Endobronchial biopsies were analyzed for reticular basement membrane (RBM) thickness and inflammatory cells.

Results

The prevalence of current respiratory and esophageal symptoms was 41% and 44%, respectively. “Doctor-diagnosed asthma” was present in 22% of patients. A restrictive and obstructive spirometric defect was observed in 32% and 30% of patients, respectively. Increased bronchial responsiveness, detected in 24% of patients, was weakly associated with current respiratory symptoms and low forced vital capacity. Mean exhaled nitric oxide was within predicted range. RBM thickness increased slightly with age, whereas inflammatory cell counts varied from normal to moderate, with intraindividual variation.

Conclusion

Inflammation of the airways in adolescents with a history of tracheoesophageal fistula, even in the presence of atopy, does not lead, in most cases, to the type of chronic inflammation and RBM changes seen in asthma.

Abbreviations: BR, Bronchial responsiveness, DDA, Doctor-diagnosed asthma, EA, Esophageal atresia, FE_NO, Fractional concentration of exhaled nitric oxide, FEV1, Forced expiratory flow in one second, FVC, Forced vital capacity, GER, Gastroesophageal reflux, PD15FEV1, Provocative dose of histamine producing a decrease of 15% in FEV1, PEF, Peak expiratory flow, PF, Pulmonary function, PFT, Pulmonary function tests, SPT, Skin prick test, RBM, Reticular basement membrane, TEF, Tracheoesophageal fistula