Examining the Esophagus: Endoscopy Utilization and Disease Progression in Adult Survivors of Esophageal Atresia/Tracheoesophageal Fistula

Presenter: Alyssa Joachim, MD

Adults with a history of esophageal atresia/tracheoesophageal fistula (EA/TEF) may develop esophageal pathology, but the pace of progression and optimal surveillance intervals remain uncertain.

This retrospective cohort study used the Epic Cosmos database to examine disease transitions among 33,335 adults with EA/TEF, with a mean follow-up of 11.8 years (interquartile range [IQR] 7.6–14.6 years) and mean age at first visit of 58 years (IQR 44–69 years). During the study period, 50% (n=16,525) underwent adult endoscopy, with a mean interval of 1.89 years (IQR 0.85–3.44 years) between procedures. Among patients with a normal baseline endoscopy, esophagitis developed in 44.1% at 5 years and 72.0% at 10 years. Progression from esophagitis to Barrett’s esophagus without dysplasia occurred in 14.2% and 21.9%, respectively. Among those with Barrett’s esophagus without dysplasia, dysplasia developed in 22.8% at 5 years and 43.3% at 10 years, while progression to esophageal cancer occurred in 2.7% and 4.0%, respectively.

The observed progression over relatively short intervals suggests that the current 5–10-year surveillance interval may be insufficient for some adults with EA/TEF, warranting further evaluation of earlier and more frequent endoscopic surveillance.

Utilization of Oral Feeding Trials and Modified Barium Swallow Studies in Infants with Congenital Diaphragmatic Hernia

Presenter: Emily Schumann, MD

Infants with congenital diaphragmatic hernia (CDH) are at increased risk of dysphagia and oral aversion, often requiring enteral nutritional support.

This single-center retrospective study evaluated infants with CDH born between January 2020 and January 2026 who underwent a modified barium swallow (MBS) before discharge. Of 92 patients who survived to discharge, 62 (67%) underwent MBS; its use increased from 54% among infants born between 2020 and 2022 to 80% between 2023 and 2026. Among infants with at least 7 days of oral feeding practice, 88% passed the MBS, compared with 33% of those with less than 7 days of oral feeding practice. A passed MBS was defined as a penetration aspiration score (PAS) <4. Among the 62 patients who underwent MBS, 24 (39%) had a gastrostomy or gastrojejunostomy tube placed before discharge, while 34 (55%) were discharged on full oral feeds.

The findings suggest that providing at least 7 days of small-volume oral feeding practice before MBS may be associated with better swallowing safety, although further studies are needed to guide enteral nutrition decisions.

Can A Redo Pull-Through for Hirschsprung's Disease Relieve a Patient’s Obstructive Symptoms?

Presenter: Marc a Levitt, MD

Persistent obstructive symptoms after primary pull-through for Hirschsprung disease (HD) may reflect anatomic or pathologic abnormalities requiring reoperation.

This single-center retrospective cohort study evaluated 42 patients who underwent redo pull-through between 2019 and 2024, with a median age of 4 years (range 6 months–13 years) and median follow-up of 12 months (range 3–47 months). Among 218 patients who were not doing well after their initial pull-through, 115 (53%) were managed medically, while 103 (47%) underwent redo surgery; 85 had obstructive indications. Transition-zone abnormality (32, 76%) and Yancey–Soave cuff (29, 69%) were the most common redo indications, with 28 (67%) having more than one indication. After redo surgery, the median obstructive symptom count decreased from 5 to 0 (p<0.001), while Hirschsprung-associated enterocolitis decreased from 71% (33) to 17% (7) (p<0.001). Daily rectal irrigation decreased from 20 (48%) to 0 patients, fecal impaction episodes from 13 (31%) to 0, and abdominal pain from 30 (71%) to 9 (21%) (all p<0.001). Patients receiving anal botulinum toxin (BT) had a greater reduction in obstructive symptoms than those who did not (-5.5 vs -2, p<0.02).

These findings indicate substantial improvement in obstructive symptom burden following redo pull-through, with additional improvement associated with BT use.

Limosilactobacillus reuteri (Lr) in its Biofilm State Protects against Hyperactivity Disorder in Survivors of Murine Necrotizing Enterocolitis

Presenter: Taylor H. Jacobs, MD

Neurodevelopmental impairment, including attention-deficit/hyperactivity disorder (ADHD), can occur in survivors of necrotizing enterocolitis (NEC).

This study examined whether a biofilm-forming enteral therapeutic containing Limosilactobacillus reuteri (Lr) adhered to dextranomer microspheres with maltose (Lr-DM-maltose) could reduce hyperactivity-like behavior after experimental NEC. Four-day-old C57BL/6 mice were assigned to NEC + Saline (n=12), NEC + Lr-DM-maltose (n=17), formula-fed/cross-fostered (n=23), dam-fed/cross-fostered (n=36), or dam-fed/non-cross-fostered normal control (n=35) groups. At two months, activity was assessed using Novel Object Recognition and Light/Dark Preference tests. Compared with normal controls, NEC + Saline mice showed greater distance traveled (p=0.05 and p=0.01), increased velocity (p=0.02), and reduced resting time (p=0.04); these measures returned to baseline with Lr-DM-maltose treatment. NEC + Saline mice also had increased hippocampal ionized calcium-binding adapter molecule 1 (Iba1) staining (p < 0.01), which was restored to baseline following treatment.

The findings suggest that biofilm-associated Lr may reduce hyperactivity-like behavior and hippocampal microglial activation following experimental NEC.

Upadacitinib in Refractory Pediatric Inflammatory Bowel Disease: Single-Center Outcomes and Colectomy Rates

Presenter: Brian T. Hickner, MD

Refractory pediatric inflammatory bowel disease (IBD) is associated with frequent biologic treatment failure and, particularly in ulcerative colitis (UC), progression to colectomy.

This retrospective single-center study evaluated patients <19 years with IBD treated with upadacitinib (UPA) between January 1, 2020 and February 1, 2026. Among 32 patients, 22 (69%) had UC, 8 (25%) Crohn’s disease (CD), 1 (3%) unclassified IBD, and 1 (3%) IBD associated with X-linked lymphoproliferative disease; all had prior anti-tumor necrosis factor exposure. Clinical response occurred in 83% at approximately 8 weeks and was maintained beyond 52 weeks in 89% of patients remaining on therapy (n=9). UPA was discontinued in 15% of the cohort, while 80% did not de-escalate to 15 mg daily during induction or subsequently required dose escalation (n=25). Endoscopic improvement occurred in all patients undergoing follow-up endoscopy (n=6). Two patients with UC underwent colectomy after UPA initiation, while none remaining on therapy beyond 52 weeks progressed to colectomy. Pediatric IBD colectomy volumes at the institution declined by 70%, from 20 cases in 2020–2023 to 6 after 2023, alongside a 32% national reduction beginning in 2024.

These findings support durable UPA responses in refractory pediatric IBD while underscoring the need for pediatric-specific dosing guidance and prospective evaluation.

American Academy of Pediatrics (AAP) National Conference & Exhibition 2026, October 2–6, San Diego, California