Sir,
Mastroianni et al. [1] report high prevalence (100%) of respiratory symptoms in their cohort of 19 children who received surgery for esophageal atresia. In contrast with the results of other studies [2], they found gastro-esophageal reflux incidence was low (26,3%). They therefore emphasize anti-reflux therapy could not be effective for treatment of respiratory symptoms in this group of patients.
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We agree with the speculation of the authors, as this was also our experience. Indeed, children who received surgical intervention for esophageal atresia have high incidence of respiratory function abnormalities [3] and bronchial hyperreactivity [4]. These conditions may be multifactorial in origin and are related to recurrent inhalation, epithelial damage, bronchial obstruction and tracheomalacia.
Treatment of underlying respiratory disease instead of anti-reflux therapy may be warranted in children with a history of surgical repair of esophageal atresia and tracheoesophageal fistula, especially when lung function studies confirm respiratory involvement.
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