what is the first correct answer and the second correct answer ?

 

[size=20px]An infant undergoes primary repair of esophageal atresia with distal tracheoesophageal fistula. As an adult, his most likely long term problem related to the esophageal atresia repair is:

 

A dysphagia

 

B symptomatic gastroesophageal reflux

 

C asthma

 

D malnutrition

 

E stricture[/size]

B

Think again my friend

B

A due to motility issues

Think again my friend

A due to motility issues

correct

 

The dysphagia that plagues older esophageal atresia patients is usually manifested by the need to drink water while eating solid food. It apparently does not change their quality of life since they have never experienced an esophagus with normal motility. Long term follow-up suggests that such dysphagia occurs in up to 85% of adults with repaired esophageal atresia compared to two percent of controls (p < 0.001).

 

Gastroesophageal reflux disease is also a common problem. Symptoms of gastroesophageal reflux were described in 34% of these adults compared to eight percent of controls (p < 0.001). Dysmotility seems to be the dominant issue with manometry demonstrating nonpropagating peristalsis in eighty percent. Late endoscopic findings include hiatal hernia (28%), Barrett esophagus (11%), esophagitis (eight percent) and anastomotic stricture (eight percent).

 

The risk of esophageal cancer in long term follow-up of esophageal atresia patients is unknown but remains of concern given the epithelial metaplastic changes and intestinal metaplasia (i.e. Barrett esophagus). Continued endoscopic surveillance may be appropriate.

 

Food impaction in older esophageal atresia patients usually occurs in the absence of a surgically significant stricture. A high prevalence of respiratory symptoms occurs among adult patients with repaired esophageal atresia. Many are diagnosed with asthma.

What is the refernce papre you used to quote these figures?

correct

 

The dysphagia that plagues older esophageal atresia patients is usually manifested by the need to drink water while eating solid food. It apparently does not change their quality of life since they have never experienced an esophagus with normal motility. Long term follow-up suggests that such dysphagia occurs in up to 85% of adults with repaired esophageal atresia compared to two percent of controls (p < 0.001).

 

Gastroesophageal reflux disease is also a common problem. Symptoms of gastroesophageal reflux were described in 34% of these adults compared to eight percent of controls (p < 0.001). Dysmotility seems to be the dominant issue with manometry demonstrating nonpropagating peristalsis in eighty percent. Late endoscopic findings include hiatal hernia (28%), Barrett esophagus (11%), esophagitis (eight percent) and anastomotic stricture (eight percent).

 

The risk of esophageal cancer in long term follow-up of esophageal atresia patients is unknown but remains of concern given the epithelial metaplastic changes and intestinal metaplasia (i.e. Barrett esophagus). Continued endoscopic surveillance may be appropriate.

 

Food impaction in older esophageal atresia patients usually occurs in the absence of a surgically significant stricture. A high prevalence of respiratory symptoms occurs among adult patients with repaired esophageal atresia. Many are diagnosed with asthma.

 

Gatzinsky V, Jönsson L, Ekerljung L, et al. Long-term respiratory symptoms following oesophageal atresia. Acta Paediatr. 2011;100(9):1222-5.

 

Pedersen RN, Markøw S, Kruse-Andersen S, et al. Esophageal atresia: gastroesophageal functional follow-up in 5-15 year old children. J Pediatr Surg. 2013;48(12):2487-95.

 

Rintala RJ, Pakarinen MP. Long-term outcome of esophageal anastomosis. Eur J Pediatr Surg. 2013;23(3):219-25.

 

Sistonen SJ, Koivusalo A, Nieminen U, et al. Esophageal morbidity and function in adults with repaired esophageal atresia with tracheoesophageal fistula: a population-based long-term follow-up. Ann Surg. 2010;251(6):1167-73.

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