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Abstract

We fully agree with JA Deurloo and DC Aronson that it is necessary to get more insight into the occurrence of esophageal cancer in patients with a history of esophageal atresia. We were unable to describe the case of Alfaro et al [ [1] Alfaro L. Bermas H. Fenolgio M. et al. Are patients who have had a tracheosophageal fistula repair during adulthood?. J Pediatr Surg. 2005; 40: 719-720 Abstract Full Text Full Text PDF PubMed Scopus (43) Google Scholar ] as our manuscript was already under review. Alfaro et al described an adenocarcinoma in Barrett dysplasia, 46 years after a repaired atresia. In our article we postulated that prolonged gastroesophageal reflux might play a role in the development of adenocarcinoma in these patients. However, in the development of squamous cell carcinoma, repeated dilatations of strictures may lead to chronic esophageal irritation. Recently, a relatively high prevalence of gastroesophageal reflux disease (GERD) was described in pediatric patients after repaired esophageal atresia compared with that in the general population [ 2 Duerloo J.A. Ekkelkamp S. Taminiau J.A. et al. Esophagitis and Barrett esophagus after correction of esophageal atresia. J Pediatr Surg. 2005; 40: 1227-1231 Abstract Full Text Full Text PDF PubMed Scopus (60) Google Scholar , 3 Krug E. Bergmeijer J.H. Dees J. et al. Gastroesophageal reflux and Barrett's esophagus in adults born with esophageal atresia. Am J Gastroenterol. 1999; 94: 2825-2828 Crossref PubMed Scopus (112) Google Scholar ]. However, no severe complications of GERD expressed by macroscopic esophagitis were found, and Barrett lesions were observed in only 1 of the 23 patients. The risk of developing Barrett esophagus is relatively low in that follow-up study on esophagogastroscopy, but it was found to be advisable in all these patients reaching adulthood until more long-term follow-up data are available. Although more than 10% of the Western population have gastroesophageal reflux, symptomatic GERD occurs in less than 40% of patients and usually requires lifelong treatment with proton pump inhibitors. Related to the low absolute risk of adenocarcinoma in a Barrett esophagus (0.5% per year), there is lack of statistical power to suggest any benefit in screening of these patients with GERD [ 4 Lagergren J. Bergstrom R. Lindgren A. et al. Symptomatic gastroesophageal reflux as a risk factor for esophageal adenocarcinoma. N Engl J Med. 1999; 340: 825-831 Crossref PubMed Scopus (2575) Google Scholar , 5 Conio M. Blanchi S. Lapertosa G. et al. Long-term endoscopic surveillance of patients with Barrett's esophagus. Incidence of dysplasia and adenocarcinoma: a prospective study. Am J Gastroenterol. 2003; 98: 1931-1939 Crossref PubMed Scopus (213) Google Scholar ]. As there is a 40-fold increased risk in patients who present with symptoms more than 3 times a week during a period of 20 years, endoscopic examination is recommended by the American College of Gastroenterology. Following these guidelines, one could recommend lifelong medical treatment in patients with GERD with repaired esophageal atresia using endoscopic screening examination at the age of 20 years.