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. © 2010 Wiley‐Liss, Inc.