Both acute and chronic problems of the respiratory tract occur frequently in our population. Three of the individuals with documented congenital heart anomalies also have pulmonary hypertension. Pulmonary hypertension, which is earlier in onset and often the cause of death in untreated DS individuals, is well reported in the literature.
Other pulmonary problems are common, including documented pneumonia in 55.2% of DS adults at some time during their residence at Woodlands. Recurrent pneumonia with incomplete recovery occurs more often as mobility declines. Of grave concern are six elderly DS individuals with chronic interstitial changes of the lungs (documented by radiography) of insidious onset, attributable to chronic, recurrent aspiration.
Respiratory problems related to aspiration are known to be associated with lower oesophageal sphincter incompetence and gastroesophageal reflux disease in the general population in patients with neurogenic dysphagia, obesity, and a sedentary lifestyle; and in handicapped persons without overt neurological deficits [Sulkes, 1986].
Gastrointestinal Disorders The most common gastrointestinal problems in infants with DS—duodenal atresia and Hirschprung disease—are not reported in our adult population. Although aspiration pneumonitis and chronic interstitial changes from presumed gastroesophageal reflux are apparent, only one of our DS adults is diagnosed with gastrointestinal reflux, recurrent esophagitis, and stricture requiring surgical treatment. Hiatal, ventral, postoperative incisional, and inguinal hernias are found in 20% of elderly DS adults. The hernias may be related to connective tissue laxity, which occurs in DS individuals of all ages.