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World J Gastroenterol. Mar 28, 2020; 26(12): 1262-1272
Published online Mar 28, 2020. doi: 10.3748/wjg.v26.i12.1262
Oesophageal atresia: The growth gap
Isabelle Traini, Jessica Menzies, Jennifer Hughes, Steven Thomas Leach, Usha Krishnan
Isabelle Traini, Steven Thomas Leach, Usha Krishnan, School of Women’s and Children’s Health, University of New South Wales, Sydney, NSW 2052, Australia
Jessica Menzies, Department of Nutrition and Dietetics, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
Jennifer Hughes, Department of Speech Pathology, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
Usha Krishnan, Department of Paediatric Gastroenterology, Sydney Children’s Hospital, Randwick, NSW 2031, Australia
Author contributions: All authors contributed to this paper with literature review and analysis, drafting, critical revision and editing, and approval of the final version.
Conflict-of-interest statement: All authors declare no conflict of interest.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Usha Krishnan, FRACP, MBBS, Senior Staff Specialist in Paediatric Gastroenterology, Director of Motility Services, and Director of Oesophageal Atresia Clinic, Department of Paediatric Gastroenterology, Sydney Children’s Hospital, High Street, Randwick, NSW 2031, Australia. usha.krishnan@health.nsw.gov.au
Received: December 12, 2019
Peer-review started: December 12, 2019
First decision: December 30, 2019
Revised: January 22, 2020
Accepted: March 9, 2020
Article in press: March 9, 2020
Published online: March 28, 2020
Processing time: 107 Days and 12 Hours
Abstract

Poor growth is an under-recognised yet significant long-term sequelae of oesophageal atresia (OA) repair. Few studies have specifically explored the reasons for growth impairment in this complex cohort. The association between poor growth with younger age and fundoplication appears to have the strongest supportive evidence, highlighting the need for early involvement of a dietitian and speech pathologist, and consideration of optimal medical reflux management prior to referring for anti-reflux surgery. However, it remains difficult to reach conclusions regarding other factors which may negatively influence growth, due to conflicting findings, inconsistent definitions and lack of validated tool utilisation. While swallowing and feeding difficulties are particularly frequent in younger children, their relationship with growth remains unclear. It is possible that these morbidities impact on the diet of children with OA, but detailed analysis of dietary composition and quality, and its relationship with these complications and growth, has not yet been conducted. Another potential area of research in OA is the role of the microbiota in growth and nutrition. While the microbiota has been linked to growth impairment in other paediatric conditions, it is yet to be investigated in OA. Further research is needed to identify the most important contributory factors to poor growth, the role of the intestinal microbiota, and effective interventions to maximise growth and nutritional outcomes in this cohort.

Keywords: Oesophageal atresia; Growth; Malnutrition; Feeding difficulty; Dysphagia; Microbiota

Core tip: Poor growth is an under-recognised yet significant long-term consequence of oesophageal atresia repair. This review highlights that the association between poor growth with younger age and fundoplication in children with oesophageal atresia appears to have the strongest supportive evidence. However, it is difficult to determine the contribution of other factors to growth, such as dysphagia, feeding difficulties, diet, and the microbiota. Early intervention of a dietitian and speech pathologist is warranted, but further research is needed to identify the most important factors related to growth, and effective interventions to maximise the growth outcomes of these children.