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

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.

Proton pump inhibitors, antibiotics, and atopy increase the risk of eosinophilic esophagitis in children with esophageal atresia

“…35 Moreover, studies found significant variation in the implementation of the guidelines, possibly due to lack of awareness thereof and/or the lack of strong evidence underlying the recommendations. 36,37 Hence, the routine use of PPIs for the first year of life as recommended by the current guidelines may need to be revisited. 3 Symptoms in the EA cohort are often nonspecific and do not help to distinguish between GERD, EoE, dysmotility, and stricture.…”

“…No association was also found between the duration of postoperative acid suppression and anastomotic stricture development 35 . Moreover, studies found significant variation in the implementation of the guidelines, possibly due to lack of awareness thereof and/or the lack of strong evidence underlying the recommendations 36,37 . Hence, the routine use of PPIs for the first year of life as recommended by the current guidelines may need to be revisited 3 .…”

Chitosan Nanoparticles for Gastroesophageal Reflux Disease Treatment

“…The choice of diagnostic approach should be guided by the patient’s specific symptoms, medical history, and clinical presentation. A multidisciplinary approach involving gastroenterologists, radiologists, and other specialists is often necessary for optimal diagnostic accuracy and management of GERD [ 10 , 50 ]. Further research and advancements in diagnostic techniques are warranted to enhance diagnostic precision and improve patient outcomes in GERD: upper endoscopy, ambulatory acid (pH) probe test [ 39 ], X-ray of the upper digestive system [ 51 ], esophageal manometry [ 51 ], and transnasal esophagoscopy [ 52 ].…”

Proton pump inhibitors in esophageal atresia: A systematic review and meta‐analysis

“…Morever, indications and duration of PPIs therapy varied widely among centers as demonstrated by a recent survey on the GERD management of EA patients. 6 Herein, we aimed to gather and review the results of available clinical studies, to evaluate evidence in the use of PPIs in pediatric patients with EA, with a special focus on benefits and risks during the first years of life.…”

“…As evidence of benefits are weak, long‐term use of PPIs raises safety concerns. Morever, indications and duration of PPIs therapy varied widely among centers as demonstrated by a recent survey on the GERD management of EA patients 6 …”