Due to copyright issues, an electronic copy of the thesis must be ordered from the faculty. For the faculty to have time to process the order, the order must be received by the faculty at the latest 2 days before the public defence. Orders received later than 2 days before the defence will not be processed. After the public defence, please address any inquiries regarding the thesis to the candidate.
Trial Lecture – time and place
See Trial Lecture.
Adjudication committee
- First opponent: Professor Helene Engstrand Lilja, Karolinska Institutet, Sweden
- Second opponent: Professor Simon Eaton, University College London, UK
- Third member and chair of the evaluation committee: Professor II Pål Aksel Næss, University of Oslo
Chair of the Defence
Professor II Inger Nina Farstad, University of Oslo
Principal Supervisor
Professor Trond H. Diseth, University of Oslo
Summary
This thesis is written in the field of pediatric surgery, with results based on a descriptive cross-sectional study of 68 adolescents with esophageal atresia (EA). The overall objective was to identify factors predicting biopsychosocial health and to define best practice of transitional care.
Gastro-esophageal reflux disease (GERD) was diagnosed in 62%, dysphagia in 85%, histological esophagitis in 92% and metaplasia in 19.5%. A new rescaled score of dysphagia by interview merged with reflux index (RI) were best predictors of esophageal metaplasia. Quality of life (QoL) was similar to healthy adolescents. Mental health scores in 12% suggested a psychiatric disorder, and 9% had high posttraumatic symptoms (PTS) scores correlated to days on the ventilator in the neonatal period. Mental strain, PTS and GERD were predictors of reduced QoL.
Impaired motor performance was diagnosed in 1/3, with balance and ball-skills mostly affected. There was a deterioration in motor performance from normal in infancy to significantly impaired in adolescence, together with lower exercise capacity. Musculoskeletal abnormalities were diagnosed in 22-78% and significant scoliosis in 12%. Musculoskeletal abnormalities and scoliosis, were significantly related to reduced physical activity and impaired motor skills. EA patients need health-promoting guidance to prevent impaired motor skills and consequences of reduced physical activity.
Merging RI and dysphagia score may be helpful in identifying EA adolescents needing endoscopy and biopsies as part of follow-up. PTS, mental health and QoL may be affected several years following neonatal treatment. Motor performance deteriorated from infancy to adolescence, and musculoskeletal abnormalities including scoliosis have a negative effect on physical activity, motor skills and exercise capacity.
Recapitulated, EA exerts its effects over the life course. Our results add to the knowledge and establishment of a multidisciplinary innovative approach.
Additional information
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