Etiological heterogeneity and clinical variability in newborns with esophageal atresia

Published: 26 January 2018

This is very long and your need to click the link below to read it all has Graphs etc.


The aim of this study was to define different characteristics of infants with esophageal atresia and correlations with the neonatal level of care, morbidity, and mortality occurring during a hospital stay.


Charts of all newborns with esophageal atresia (EA) admitted to our University NICU between January 2003 and November 2016 were reviewed and subdivided in four groups related to different clinical presentations; EA as an isolated form (A), with a concomitant single malformation (B), as VACTERL association (C), and in the context of a syndrome or an entity of multiple congenital anomalies (D).


We recruited 67 infants with EA (with or without tracheoesophageal fistula), distributed in groups as follows: A 31.3%, B 16.4%, C 26.8% and D 25.3%. Type of atresia was not statistically different among different groups. Mortality was higher in groups C and D, especially if associated with congenital heart defects.

In survivors, we found different auxological evolution and prognostic profiles considering duration in days of invasive mechanical ventilation and total parenteral nutrition, as well as the length of stay and corrected gestational age at discharge.


In the context of genetic and syndromic entities, subjects with VACTERL association showed a lower mortality rate although a higher and more complex level of intensive care was noted in comparison to infants without VACTERL genetic and syndromic entities.

Read on.



Twin pregnancy complicated by esophageal atresia, duodenal atresia, gastric perforation, and hypoplastic left heart structures in one twin: a case report and review of the literature.

Published: 18 March 2017


Respiratory problems in children with esophageal atresia and tracheoesophageal fistula

Published: 5 September 2017


Esophageal Atresia With or Without Tracheoesophageal Fistula Treatment and Management

Updated: May 11, 2017

Click on link below there are Graph’s and a Video and quite a few pages to read through

Approach Considerations

The treatment plan for each baby must be individualized. The prognostic classifications (see Indications for and Timing of Surgical Intervention below) can provide guidance to patients with multiple problems, but early and decisive identification of the most life-threatening anomaly is essential.

Management plans for a delayed repair of the esophageal atresia may include placing a 10-French Replogle double-lumen tube through the mouth or nose well into the upper pouch to provide continuous suction of pooled secretions from the proximal portion of the atretic esophagus. The baby may be positioned in the 45° sitting position. Prophylactic broad-spectrum antibiotics (eg, ampicillin and gentamicin) may be used. General supportive care and total parenteral nutrition are needed.


With careful bedside attendance, these measures may permit a delay of days to perhaps weeks. Some have described cases in which the baby was discharged home with a Replogle tube in situ while waiting for staged repair of an esophageal atresia. However, deaths have been reported in infants in whom the tube did not maintain an empty upper pouch. A gastrostomy, distal tracheoesophageal fistula (TEF) ligation, or cervical esophagostomy may permit longer delays in the esophageal atresia repair. However, each intrusion carries a price.

If no distal TEF is present, a gastrostomy may be created. In such cases, the stomach is small, and laparotomy is required. In all cases of esophageal atresia in which a gastrostomy is created, care should be taken to place it near the lesser curvature to avoid damaging the greater curvature, which can be used in the formation of an esophageal substitute. When a baby is ventilated with high pressures, the gastrostomy may offer a route of decreased resistance, causing the ventilation gases to flow through the distal fistula and out the gastrostomy site. This condition may complicate the use of ventilation.

Many Pages linked to this.


Barrett’s Esophagus Studies

Barrett’s Esophagus studies 2018 – 2017

Swallowable Balloon Device Detects Barrett’s Esophagus

January 22, 2018

A small device that patients can swallow in any outpatient setting without being under sedation should allow for earlier detection of Barrett’s esophagus (BE) and thereby prevent the development of esophageal adenocarcinoma (EAC), which can arise from these premalignant lesions.

The device, which is about the size of a vitamin pill, could be used for screening instead of the more invasive endoscopy, say the researchers. It could be used as an easy, inexpensive “one-time” test that physicians can use to screen all patients older than 50 years, the researchers suggest.


“Our current understanding is that EACs virtually all arise from BE,” senior author Sanford Markowitz, MD, PhD Ingalls professor of cancer genetics, Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio, told Medscape Medical News.

We should be able to prevent the greater majority of EACs from ever developing.Dr. Sanford Markowitz

“If we could identify everyone with BE and resect or ablate the BE when it shows dysplasia, we should be able to prevent the greater majority of EACs from ever developing,” he added.

The incidence of EAC has “steadily increased” in the recent past, and esophageal cancer is still associated with a poor prognosis, the authors note. 

Patients at highest risk for BE are white men older than 50 who have persistent heartburn.

Typically, to confirm the diagnosis for these high-risk patients, physicians perform endoscopy and biopsy of the target lesion.

“If the biopsy shows changes towards becoming frank cancer, then the Barrett’s can be removed through the endoscopy by a process called endomucosal resection,” Dr. Markowitz explained. Alternatively, lesions can be burned away with radiofrequency ablation or frozen off through cryoablation.

The new device, which is less invasive than endoscopy, could be used to screen all individuals older than 50, instead of only patients at high risk, the researchers suggest.

READ MORE ON THIS Developing the Device.


Aspirin Use is Associated With Lower Risk of Barrett’s Esophagus in Women

Published online:


Barrett’s esophagus (BE) is the only known precursor to esophageal adenocarcinoma. Data examining the association of aspirin with the onset of BE, particularly for women, are scant and conflicting.


We leveraged data from 121,700 women enrolled in the Nurses’ Health Study, a large prospective cohort study, who biennially provided detailed information regarding endoscopy and use of aspirin. We used unconditional logistic regression to obtain multivariable (MV)-adjusted odds ratios (ORs) and 95% confidence intervals (CI) to estimate the risk of BE in regular aspirin users (≥2 times/week) compared to non-regular users.


Among 27,881 women who had undergone upper GI endoscopy, we documented 667 BE cases over 18 years of follow-up. Compared to non-regular users, women who regularly used aspirin had a MV-adjusted OR for BE of 0.85 (95%CI: 0.72, 0.99). The corresponding OR was 0.73 (95%CI: 0.56, 0.96) for BE at least 1 cm long. Compared with women who did not use any aspirin, the MV-adjusted OR for any BE was 0.91 (95% CI, 0.69, 1.20) for women taking 0.5-1.5 tablets/week; 0.92 (95%CI 0.76, 1.11) for 2–5 tablets/week; and 0.71 (95%CI 0.55, 0.92) for ≥6 tablets/week (p-trend=0.01). Compared with non-regular users, the MV-adjusted OR for BE risk was 0.90 (95%CI 0.67, 1.20) for women who regularly used aspirin for 1–5 years, 0.84 (95%CI 0.65, 1.09) for 6–10 years, and 0.81 (95%CI 0.67, 0.97) for >10 years (p-trend=0.03).


Regular aspirin use was associated with a reduction in the risk of Barrett’s esophagus in women. The reduction in risk appeared related to higher dose and longer duration of use.

For rest of report click on the link below


Esophageal Cancer in Relative Increases Barretts

Barrett’s esophagus refers to an abnormal change (metaplasia) in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by simple columnar epithelium with goblet cells.

While it is well known that esophageal adenocarcinoma is a common complication of Barrett’s esophagus, the significance of family history of esophageal adenocarcinoma in disease progression among patients with Barrett’s esophagus is not well-known. Patients with Barrett’s esophagus who have a first-degree relative with esophageal adenocarcinoma are at 5.5-fold increased risk for progression to esophageal adenocarcinoma.


Transitional basal cells at the squamous–columnar junction generate Barrett’s oesophagus

(26 October 2017)

In several organ systems, the transitional zone between different types of epithelium is a hotspot for pre-neoplastic metaplasia and malignancy, but the cells of origin for these metaplastic epithelia and subsequent malignancies remain unknown. In the case of Barrett’s oesophagus, intestinal metaplasia occurs at the gastro-oesophageal junction, where stratified squamous epithelium transitions into simple columnar cells. On the basis of a number of experimental models, several alternative cell types have been proposed as the source of this metaplasia but in all cases the evidence is inconclusive: no model completely mimics Barrett’s oesophagus in terms of the presence of intestinal goblet cells.


Useful Links...