Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2022 Aug 1;75(2):145-150.
doi: 10.1097/MPG.0000000000003483. Epub 2022 Jun 7.

Management of Gastroesophageal Reflux Disease in Esophageal Atresia Patients: A Cross-Sectional Survey amongst International Clinicians

Marinde van Lennep  1 , Frederic Gottrand  2 , Christophe Faure  3 , Taher I Omari  4 , Marc A Benninga  1 , Michiel P van Wijk  1   5 , Usha Krishnan  6   7
Affiliations
Multicenter Study

Management of Gastroesophageal Reflux Disease in Esophageal Atresia Patients: A Cross-Sectional Survey amongst International Clinicians

Marinde van Lennep et al. J Pediatr Gastroenterol Nutr. .

Abstract

Objectives: After surgical repair, up to 70% of esophageal atresia (EA) patients suffer from gastroesophageal reflux disease (GERD). The ESPGHAN/NASPGHAN guidelines on management of gastrointestinal complications in EA patients were published in 2016. Yet, the implementation of recommendations on GERD management remains poor.We aimed to assess GERD management in EA patients in more detail, to identify management inconsistencies, gaps in current knowledge, and future directions for research.

Methods: A digital questionnaire on GERD management in EA patients was sent to all members of the ESPGHAN EA working group and members of the International network of esophageal atresia (INoEA).

Results: Forty responses were received. Thirty-five (87.5%) clinicians routinely prescribed acid suppressive therapy for 1-24 (median 12) months. A fundoplication was considered by 90.0% of clinicians in case of refractory GERD with persistent symptoms despite maximal acid suppressive therapy and in 92.5% of clinicians in case of GERD with presence of esophagitis on EGD. Half of clinicians referred patients with recurrent strictures or dependence on transpyloric feeds. Up to 25.0% of clinicians also referred all long-gap EA patients for fundoplication, those with long-term need of acid suppressants, recurrent chest infections and feedings difficulties.

Conclusions: Respondents' opinions on the optimal duration for routine acid suppressive therapy and indications for fundoplication in EA patients varied widely. To improve evidence-based care for EA patients, future prospective multicenter outcome studies should compare different diagnostic and treatment regimes for GERD in patients with EA. Complications of therapy should be one of the main outcome measures in such trials.

PubMed Disclaimer

Conflict of interest statement

The authors report no conflicts of interest.

Figures

FIGURE 1.
FIGURE 1.
Flowchart of questionnaire responses.
FIGURE 2.
FIGURE 2.
Routinely performed investigations for GERD in EA patients. EGD = esophagogastroduodenoscopy with biopsies; CE = contrast esophagogram; pH ± MII = 24 hour pH-metry with/without impedance; scinti = nuclear scintigraphy; symptom = symptom assessment.
FIGURE 3.
FIGURE 3.
Routinely performed investigations before fundoplication in EA patients. CE = contrast esophagogram; EGD = esophagogastroduodenoscopy with biopsies; pH ± MII = 24 hour pH-metry with/without impedance.
See this image and copyright information in PMC

References

    1. Pedersen RN, Calzolari E, Husby S, et al. . Oesophageal atresia: prevalence, prenatal diagnosis and associated anomalies in 23 European regions. Arch Dis Child. 2012;97:227–32. - PubMed
    1. Nassar N, Leoncini E, Amar E, et al. . Prevalence of esophageal atresia among 18 international birth defects surveillance programs. Birth Defects Res A Clin Mol Teratol. 2012;94:893–9. - PMC - PubMed
    1. Catalano P, Di Pace MR, Caruso AM, et al. . Gastroesophageal reflux in young children treated for esophageal atresia: evaluation with pH-multichannel intraluminal impedance. J Pediatr Gastroenterol Nutr. 2011;52:686–90. - PubMed
    1. Castilloux J, Soglio DB-D, Faure C, et al. . Endoscopic assessment of children with esophageal atresia: lack of relationship of esophagitis and esophageal metaplasia to symptomatology. Can J Gastroenterol. 2010;24:312–6. - PMC - PubMed
    1. Koivusalo A, Pakarinen MP, Rintala RJ, et al. . The cumulative incidence of significant gastrooesophageal reflux in patients with oesophageal atresia with a distal fistula—a systematic clinical, pH-metric, and endoscopic follow-up study. J Pediatr Surg. 2007;42:370–4. - PubMed

Publication types

MeSH terms