Congenital Esophageal Atresia (EA) is a serious neonatal GI malformation with an incidence of about 1/3000~4000 and a 100% natural mortality rate, and is often associated with a variety of other systemic malformations and chromosomal abnormalities. Congenital esophageal atresia is often combined with tracheoesophageal fistula (TEF), and currently, the Gross classification is mostly used, and EA/TEF can be divided into 5 types, of which the most common is type III, which is also the type with better surgical results, accounting for about 88.5%. Every year, there are about 50,000 new cases of EA/TEF in China. With the development of neonatal disciplines, improved surgical techniques, and improved monitoring, the mortality rate of esophageal atresia in the neonatal period has been greatly reduced, and the success rate has reached more than 90-95 percent. The gradual increase in long-term surviving patients has prompted a shift in international clinical focus from perioperative complications (pneumonia, anastomotic fistula, infection, etc.) to the study of distant complications (esophageal function, pulmonary disease, esophageal chemosis, carcinoma). Gastrointestinal symptoms are very common in children after EA/TEF and can cause growth to lag behind that of their normal peers. Using esophageal manometry, studies have shown that more than 75% of children with EA/TEF have abnormal esophageal motility in childhood and adulthood, and 100% of children with colonic substitutes have abnormal esophageal motility. Many post-EA/TEF children need to “chew and swallow”. In adults, 53-92% of patients have occasional dysphagia, and 13%-20% of adults have daily dysphagia. One study noted that the percentage of postoperative children hospitalized for GI symptoms by age 10 was approximately 65%, a figure that decreases to 3% after age 18. Children with long spaced esophageal atresia requiring delayed, staged surgery or colonic substitution for the esophagus are at high risk of developing distant esophageal motility abnormalities, dysphagia, and gastroesophageal reflux. Gastroesophageal reflux is a common complication in children with congenital esophageal atresia. The percentage of patients with postoperative gastroesophageal reflux in childhood ranges from 35% to 58% and decreases to 11% in adulthood. Large foreign research centers use combined esophageal manometry and PH monitoring to study and clarify the diagnosis. Gastroesophageal reflux is often associated with abnormal esophageal dynamics or a short ventral esophagus due to anastomotic surgery. Anastomotic fistula after esophageal atresia is a recent complication of surgery and 95% of them can be cured spontaneously by closed chest drainage and antibiotics, but it can have a significant impact on long-term esophageal function, such as distant esophageal stricture and recurrence of esophageal-tracheal fistula. The incidence of esophageal stricture is approximately 6% to 40%, and is more common in children with long spaced (>2.5 cm) esophageal atresia due to higher anastomotic tension. Although the use of absorbable surgical sutures, interrupted sutures, has been reported to help reduce distal anastomotic strictures, there is no evidence of evidence-based medicine. Distant esophageal anastomotic strictures require multiple dilatations to resolve the problem. One study showed that in postoperative children without gastroesophageal reflux, the percentage of stenosis was 22%, while children with gastroesophageal reflux were more likely to develop esophageal stenosis, about 52%. Respiratory complications are common in children with postoperative congenital esophageal atresia, with a rate of 46%. 19% of these patients have recurrent pneumonia, 10% have respiratory distress, and 13% develop cough and cyanosis during feeding. Delius et al. concluded that the causes of respiratory complications are complex, but 74% of respiratory complications are related to gastroesophageal reflux. This shows that long-term postoperative complications such as growth retardation, feeding difficulties, esophageal stricture, and recurrent respiratory infections are mostly associated with abnormal esophageal function such as esophageal dynamics and gastroesophageal reflux. Congenital esophageal atresia is no longer a mere neonatal surgical disease; postoperative dysphagia, pneumonia, airway hyperreactivity, gastroesophageal reflux, and growth and development have become lifelong concerns for patients, especially the prognostic regression of esophageal mucosa, such as Barrett’s esophagus and cancer tendency, have become an important direction for future research, which are invariably closely related to patients’ postoperative esophageal function. At present, domestic and foreign studies on esophageal function mainly include: esophageal pressure measurement, 24-hour PH monitoring, standard acid reflux test, acid perfusion test, acid clearance test, radionuclide examination (including checking gastroesophageal reflux and esophageal passage function), mucosal potential difference measurement, etc. The two most commonly used and useful methods are esophageal manometry and 24-hour esophageal PH monitoring, which can also be widely performed at present. Abroad, esophageal function tests are mainly used for research and prevention of benign esophageal diseases. As mentioned above, some pediatric surgical treatment centers have been studying long-term esophageal complications after esophageal atresia for nearly 20 years and have established a perfect follow-up study system, and their reports have high reference value. In contrast, the diagnosis and treatment of benign esophageal diseases in China is at a low level, and the examination of pediatric esophageal function is only carried out in a few large pediatric disease centers, and there are almost no relevant reports on the study of long-term esophageal function after esophageal atresia in childhood and adulthood. Therefore, it is important to improve the follow-up database of children with esophageal atresia, to perform long-term follow-up and testing of esophageal function, to establish a map of abnormal esophageal function in children with esophageal atresia, and to provide timely clinical interventions needed, such as anti-reflux drugs, fundoplication surgery, esophageal stricture dilatation, and even esophageal replacement surgery, to improve patients’ esophageal function, reduce the incidence of respiratory diseases, promote growth and development, and advance detection of precancerous lesions, thus improving the quality of life and achieving a happy life!