Pulmonary Function Impairment After Trachea-Esophageal Fistula: A Minor Role for Gastro-Esophageal Reflux Disease

Background: Long-term impairment of pulmonary function in trachea-esophageal fistula (TEF) patients is, at least in part, commonly ascribed to gastro-esophageal reflux disease (GERD). The objective of this study was to examine the independent effects of the underlying condition and GERD on cardiopulmonary function. Methods: Cardiopulmonary function of TEF patients, who had (severe) GERD (s-GERD) requiring antireflux surgery (TEF_GERD, n = 11) and TEF patients who did not have s-GERD (group TEF-GERD, n = 20) were compared with control patients who had isolated s-GERD requiring antireflux surgery (group GERD, n = 13). All patients performed spirometry, lung volume measurements, measurement of diffusion capacity and maximal cardiopulmonary exercise testing (CPET). Results: Mean age of the participants was 13.8 +/- 2.7 (group TEF_GERD). 13.2 +/- 2.9 (group TEF-GERD), and 14.7 +/- 1.5 years (group GERD). FVC and TLC were significantly lower in patients with TEF (with and without s-GERD) when compared to patients with isolated s-GERD. Most pulmonary function parameters were similarly affected in both TEF groups, but FEV1 was lower in the TEF+GERD group than in the TEF-GERD group. Cardiopulmonary exercise parameters were similar in all groups. Conclusions: TEF patients had restrictive lung function impairment when compared to patients with isolated s-GERD. This difference may be due to several causes, including thoracotomy. FEV1 was lower in TEF+GERD when compared to TEF-GERD indicating that GERD may affect large airway function in TEF patients. Other differences between TEF patients with and without s-GERD were not significant, suggesting only a minor role for GERD. Pediatr Pulmonol. 2011; 46: 348-355. (C) 2010 Wiley-Liss, Inc