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Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia

Chronic, long-term respiratory morbidity (CRM) is common in patients with a history of repaired congenital esophageal atresia, typically associated with tracheoesophageal fistula (EA/TEF). EA/TEF patients are at high risk of having aspiration, and retrospective studies have associated CRM with both...

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Autor principal: Kovesi, Thomas
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376561/
https://www.ncbi.nlm.nih.gov/pubmed/28421172
http://dx.doi.org/10.3389/fped.2017.00062
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author Kovesi, Thomas
author_facet Kovesi, Thomas
author_sort Kovesi, Thomas
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description Chronic, long-term respiratory morbidity (CRM) is common in patients with a history of repaired congenital esophageal atresia, typically associated with tracheoesophageal fistula (EA/TEF). EA/TEF patients are at high risk of having aspiration, and retrospective studies have associated CRM with both recurrent aspiration and atopy. However, studies evaluating the association between CRM in this population and either aspiration or atopy have reported conflicting results. Furthermore, CRM in this population may be due to other related conditions as well, such as tracheomalacia and/or recurrent infections. Aspiration is difficult to confirm, short of lung biopsy. Moreover, even within the largest evidence base assessing the association between CRM and aspiration, which has evaluated the potential relationship between gastroesophageal reflux and asthma, findings are contradictory. Studies attempting to relate CRM to prior aspiration events may inadequately estimate the frequency and severity of previous aspiration episodes. There is convincing evidence documenting that chronic, massive aspiration in patients with repaired EA/TEF is associated with the development of bronchiectasis. While chronic aspiration is likely associated with other CRM in patients with repaired EA/TEF, this does not appear to have been confirmed by the data currently available. Prospective studies that systematically evaluate aspiration risk and allergic disease in patients with repaired EA/TEF and document subsequent CRM will be needed to clarify the causes of CRM in this population. Given the prevalence of CRM, patients with repaired EA/TEF should ideally receive regular follow-up by multidisciplinary teams with expertise in this condition, throughout both childhood and adulthood.
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spelling pubmed-53765612017-04-18 Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia Kovesi, Thomas Front Pediatr Pediatrics Chronic, long-term respiratory morbidity (CRM) is common in patients with a history of repaired congenital esophageal atresia, typically associated with tracheoesophageal fistula (EA/TEF). EA/TEF patients are at high risk of having aspiration, and retrospective studies have associated CRM with both recurrent aspiration and atopy. However, studies evaluating the association between CRM in this population and either aspiration or atopy have reported conflicting results. Furthermore, CRM in this population may be due to other related conditions as well, such as tracheomalacia and/or recurrent infections. Aspiration is difficult to confirm, short of lung biopsy. Moreover, even within the largest evidence base assessing the association between CRM and aspiration, which has evaluated the potential relationship between gastroesophageal reflux and asthma, findings are contradictory. Studies attempting to relate CRM to prior aspiration events may inadequately estimate the frequency and severity of previous aspiration episodes. There is convincing evidence documenting that chronic, massive aspiration in patients with repaired EA/TEF is associated with the development of bronchiectasis. While chronic aspiration is likely associated with other CRM in patients with repaired EA/TEF, this does not appear to have been confirmed by the data currently available. Prospective studies that systematically evaluate aspiration risk and allergic disease in patients with repaired EA/TEF and document subsequent CRM will be needed to clarify the causes of CRM in this population. Given the prevalence of CRM, patients with repaired EA/TEF should ideally receive regular follow-up by multidisciplinary teams with expertise in this condition, throughout both childhood and adulthood. Frontiers Media S.A. 2017-04-03 /pmc/articles/PMC5376561/ /pubmed/28421172 http://dx.doi.org/10.3389/fped.2017.00062 Text en Copyright © 2017 Kovesi. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Kovesi, Thomas
Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia
title Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia
title_full Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia
title_fullStr Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia
title_full_unstemmed Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia
title_short Aspiration Risk and Respiratory Complications in Patients with Esophageal Atresia
title_sort aspiration risk and respiratory complications in patients with esophageal atresia
topic Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5376561/
https://www.ncbi.nlm.nih.gov/pubmed/28421172
http://dx.doi.org/10.3389/fped.2017.00062
work_keys_str_mv AT kovesithomas aspirationriskandrespiratorycomplicationsinpatientswithesophagealatresia