In 8th grade, our English teacher would say ‘Esophagus, recite that poem.’ He would say this to everybody. It is possible that the flask that he carried could have influenced his word choice.
That anecdote came to mind as reading a recent article (K Birketvedt et al. J Pediatr 2020; 218: 130-7) which showed that a large number of adolescents with history of esophageal disease (esophageal atresia [EA]) had a high likelihood of suboptimal nutritional parameters. In this study with 68 pediatric subjects, extensive investigations including 4-day diet records, blood tests, pH measuring, EAT (eating assessment test) questionnaire, and interviews. Median age at follow-up was 16 years.
Key findings:
- Median height-for-age Z score was -0.6. 10 patients (15%) were considered stunted (height-for-age Z score <-2).
- More than two-thirds reported symptoms of dysphagia (EAT score ≥3) and avoided specific foods.
- 48 (71%) had suboptimal energy intake on diet records –intake below age-appropriate recommendations. Many had low vitamin D and iron intake.
- 13 of 68 patients had VACTERL association and 17 (25%) had congenital heart disease
My take: If your esophagus is not working right, it definitely can impair one’s nutritional status. Some patients have other reasons (other comorbidities) that could influence these reported results.
As for the anecdote, I still remember some of the poems we had to recite. The one I remember best:
To An Athlete Dying Young A. E. Housman – 1859-1936
To-day, the road all runners come,
Shoulder-high we bring you home,
And set you at your threshold down,
Townsman of a stiller town.
Smart lad, to slip betimes away
From fields where glory does not stay,
And early though the laurel grows
It withers quicker than the rose.
Eyes the shady night has shut
Cannot see the record cut,
And silence sounds no worse than cheers
After earth has stopped the ears:
Now you will not swell the rout
Of lads that wore their honours out,
Runners whom renown outran
And the name died before the man.
So set, before its echoes fade,
The fleet foot on the sill of shade,
And hold to the low lintel up
The still-defended challenge-cup.
And round that early-laurelled head
Will flock to gaze the strengthless dead,
And find unwithered on its curls
The garland briefer than a girl’s.
Related blog posts:
- Esophagitis in Pediatric Esophageal Atresia This study (n=310) showed a significant rate of esophagitis (eosinophilic and noneosinophilic) and indicates need for careful followup.
- Guidelines for esophageal atresia-TEF
- Increased Risk of Eosinophilic Esophagitis with Esophageal Atresia
- Never quite right | gutsandgrowth,
- Endoscopic Surveillance after Esophageal Atresia: Low Yield in Pediatrics
- Declining Role of Fundoplication in Esophageal Atresia, Too
