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Bagci S.,University of Bonn | Brosens E.,Erasmus Medical Center | Tibboel D.,Erasmus Medical CentreSophia Childrens Hospital | De Klein A.,Erasmus Medical Center | And 23 more authors.
European Journal of Pediatrics | Year: 2016

The purpose of our study was to investigate the importance of amniotic fluid (AF) for fetal growth during late gestation using esophageal atresia (EA) patients as a model. In this retrospective cohort study, we compared the z-scores adapted for birth weights (BW z-scores) for each of 517 European newborns with congenital pre-gastric intestinal atresia, i.e., EA, to a European reference population. To account for the influence of the intestinal atresia on fetal growth per se, we compared adapted birth weights for each of 504 European newborns with post colonic intestinal atresia (anorectal malformation (ARM) with atresia of the anus) to the same European reference population. Analysis of the complete cohort showed (i) a significantly higher rate of small for gestational age newborns among EA compared to ARM newborns (p < 0.001) and (ii) significantly lower BW z-scores among EA compared to ARM newborns (p < 0.001). BW z-scores of EA newborns were significantly lower in term compared to preterm newborns with an inverse correlation with gestational age (GA) (Spearman correlation coefficient, r = −0.185, p < 0.001). Conclusions: Enteral uptake of AF seems to play a pivotal role in fetal growth during late gestation.What is Known:• Peak velocity of fetal weight gain occurs at 33 weeks of gestation and continues until birth. During this period, fetal growth is mainly characterized by cellular hypertrophy.• Amniotic fluid (AF) comprises large amounts of hormones and growth regulators.What is New:• A significantly higher rate of small for gestational age and lower birth weights and z-scores are observed among newborn infants with congenital pre-gastric intestinal atresia.• These findings suggest that enteral uptake of AF is a major predictor for fetal growth during late gestation. © 2016, Springer-Verlag Berlin Heidelberg.

Behrens A.,University Medicine of Mainz | Pech O.,University Medicine of Mainz
Nature Reviews Gastroenterology and Hepatology | Year: 2011

A recent position paper by the American Gastroenterological Association has made a range of excellent recommendations for the management of patients with Barrett esophagus. However, the guidelines have several important limitations, including the omission of endoscopic therapy for patients who have T1 Barrett adenocarcinoma.

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