Cardiorespiratory performance capacity and airway microbiome in patients following primary repair of esophageal atresia

Christoph Arneitz; Jana Windhaber; Christoph Castellani; Bernhard Kienesberger; Ingeborg Klymiuk; Günter Fasching; Holger Till; Georg Singer

doi:10.1038/s41390-020-01222-7

Cardiorespiratory performance capacity and airway microbiome in patients following primary repair of esophageal atresia

Pediatr Res. 2021 Jul;90(1):66-73. doi: 10.1038/s41390-020-01222-7. Epub 2020 Nov 6.

Authors

Christoph Arneitz¹, Jana Windhaber¹, Christoph Castellani², Bernhard Kienesberger¹, Ingeborg Klymiuk³, Günter Fasching⁴, Holger Till¹, Georg Singer¹

Affiliations

¹ Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria.
² Department of Paediatric and Adolescent Surgery, Medical University of Graz, Graz, Austria. christoph.castellani@medunigraz.at.
³ Core Facility Molecular Biology, Center for Medical Research, Medical University of Graz, Graz, Austria.
⁴ Department of Paediatric and Adolescent Surgery, Clinical Center Klagenfurt, Klagenfurt, Austria.

Abstract

Background: Patients following repair of an esophageal atresia (EA) or tracheoesophageal fistula (TEF) carry an increased risk of long-term cardiopulmonary malaise. The role of the airway microbiome in EA/TEF patients remains unclear.

Methods: All EA/TEF patients treated between 1980 and 2010 were invited to a prospective clinical examination, spirometry, and spiroergometry. The airway microbiome was determined from deep induced sputum by 16 S rRNA gene sequencing. The results were compared to a healthy age- and sex-matched control group.

Results: Nineteen EA/TEF patients with a mean age of 24.7 ± 7 years and 19 age- and sex-matched controls were included. EA/TEF patients showed a significantly lower muscle mass, lower maximum vital capacity (VC_max), and higher rates of restrictive ventilation disorders. Spiroergometry revealed a significantly lower relative performance capacity and lower peak VO₂ in EA/TEF patients. Alpha- and beta-diversity of the airway microbiome did not differ significantly between the two groups. Linear discriminant effect size analysis revealed significantly enriched species of Prevotella_uncultured, Streptococcus_anginosus, Prevotella_7_Prevotella_enoeca, and Mogibacterium_timidum.

Conclusion: EA/TEF patients frequently suffer from restrictive ventilation disorders and impaired cardiopulmonary function associated with minor alterations of the airway microbiome. Long-term examinations of EA/TEF patients seem to be necessary in order to detect impaired cardiopulmonary function.

Impact: The key messages of the present study are a significantly decreased VC_max and exercise performance, as well as airway microbiome differences in EA/TEF patients. This study is the first to present parameters of lung function and exercise performance in combination with airway microbiome analysis with a mean follow-up of 24 years in EA/TEF patients. Prospective, long-term studies are needed to unravel possible interactions between alterations of the airway microbiome and impaired pulmonary function in EA/TEF patients.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Case-Control Studies
Esophageal Atresia / microbiology
Esophageal Atresia / physiopathology
Esophageal Atresia / surgery*
Female
Humans
Male
Microbiota*
Prospective Studies
Young Adult