Gastroesophageal reflux and Barrett's esophagus in adults born with esophageal atresia

OBJECTIVE: Postoperative morbidity after correction of esophageal atresia i s partly determined by gastroesophageal reflux disease, which has been prov en to affect from one-half to two-thirds of patients during childhood. We c onducted a follow-up study to test our hypothesis that, if former patients still show gastroesophageal reflux at adult age, they are at high risk for developing Barrett's esophagus, which is considered to be premalignant. METHODS: Of 69 patients born between 1971 and 1978, all having undergone a primary anastomosis, 24 had died, five of them because of aspiration. Of th e 45 survivors, 39 could be traced; they all completed a questionnaire inqu iring after symptoms related to the esophagus. Of these patients, 34 underw ent an additional esophagogastrocopy. R ESULTS: Only nine of the 39 patients had no symptoms at all; 30 had mild to severe dysphagia symptoms, and 13 had mild to severe reflux symptoms. Esop hagogastrocopy in 34 patients revealed that the anastomosis was still recog nizable in all cases, but stenoses were not found. Six patients showed a sm all hiatal hernia, and one a large one. The incidences of reflux symptoms ( 13/39, p < 0.01), reflux esophagitis (9/34, p < 0.01) and Barrett's esophag us (2/34, p < 0.001) were significantly higher than in the normal populatio n. CONCLUSIONS: This group seems to be at risk for developing Barrett's esopha gus. As this is the first follow-up study of a consecutive group of adult e sophageal atresia patients, we think it is advisable to perform an esophago gastroscopy in all patients at adulthood until more long term follow-up dat a are available. (C) 1999 by Am. Cell. of Gastroenterology.