Swallowing dysfunction in patients with esophageal atresia-tracheoesophageal fistula: infancy to adulthood

Abstract

Esophageal dysfunction is a common problem in children with repaired esophageal atresia-tracheoesophageal fistula (EA-TEF) and considered as a long-term sequel of the cases. Impaired esophageal motility in EA survivors is multifactorial and is attributed to primary abnormality of esophageal innervation and vagal nerve damage during esophageal repair (1). Dysphagia, regurgitation, aspiration and chronic respiratory tract infections are considered as clinical findings of esophageal dysmotility (2). In addition to esophageal motility problems, 28% of patients with EA-TEF had oropharyngeal impairment causing swallowing dysfunction (SD) (2). Due to lack of objective criteria there is a wide variation in prevalence of SD in children with EA-TEF. Gibreel et al. reported that 82% of cases show some degree of SD in adulthood and most of the cases had mild symptoms that not affect the food choices of patients (3). Another study evaluating the dysphagia in adult EA survivors report dysphagia with a prevalence of 57% by using a symptom score test (4). Dysphagia is the most common symptom in patients with EA of all ages and incidence is varying depending on the definition. It has been shown that incidence is lower in infants than children and adults (5). Also, diagnostic methods that used to evaluate the dysphagia are responsible from the varying data. In this review, definition, diagnostic methods and clinical course of SD in patients with EA-TEF will be summarized from infancy to adulthood.