Intestinal Metaplasia of the Esophagus in Children With Esophageal Atresia

J Pediatr Gastroenterol Nutr. 2017 Jul;65(1):e1-e4. doi: 10.1097/MPG.0000000000001558.


Objectives: Patients with esophageal atresia/tracheoesophageal fistula (EA-TEF) can develop Barrett esophagus as a long-term consequence of their condition. Intestinal metaplasia (IM), a risk factor for developing adenocarcinoma of the esophagus, has not been well characterized in the pediatric population.

Methods: Retrospective review of patients with EA-TEF followed at 3 academic pediatric centers between the years 1997 and 2014.

Results: Among 542 children and adolescents, 1.3% (7 patients, 5 girls) were diagnosed with IM based on endoscopy and pathology. Six of the patients had EA-TEF type C, whereas the last patient had a "long gap" type A atresia. Patients were diagnosed with gastric metaplasia either before the IM diagnosis in 4 patients or concomitantly in 3. The median (range) age of diagnosis for gastric metaplasia was 7.9 (range 2-17.2) and for IM 10.9 (2-17.2) years. Gastroesophageal reflux (GER) symptoms were nonspecific. Five patients were on proton pump inhibitor therapy for symptomatic GER at the time of diagnosis of IM. 2 of the 7 patients had previously undergone Nissen fundoplication. One patient, who had undergone a Nissen fundoplication, was restarted on proton pump inhibitor once the diagnosis of IM was made. All patients had repeated endoscopy and dysplasia was not observed with a median follow-up of 1.7 (range 1-4.9) years.

Conclusions: IM occurs in patients with EA-TEF, some as young as 2 years. Therefore, early endoscopic surveillance should be considered in this GER-prone population.

Publication types

  • Multicenter Study

MeSH terms

  • Adolescent
  • Aftercare
  • Barrett Esophagus / etiology
  • Barrett Esophagus / pathology
  • Child
  • Child, Preschool
  • Esophageal Atresia / diagnostic imaging
  • Esophageal Atresia / pathology*
  • Esophageal Atresia / surgery
  • Esophagoscopy
  • Esophagus / diagnostic imaging
  • Esophagus / pathology*
  • Female
  • Follow-Up Studies
  • Gastroesophageal Reflux / etiology
  • Gastroesophageal Reflux / pathology
  • Humans
  • Intestines
  • Male
  • Metaplasia
  • Retrospective Studies
  • Tracheoesophageal Fistula / diagnostic imaging
  • Tracheoesophageal Fistula / pathology*
  • Tracheoesophageal Fistula / surgery

Supplementary concepts

  • Esophageal atresia with or without tracheoesophageal fistula