Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia

Hagander, Lars; Muszynska, Carolina; Arnbjörnsson, Einar; Sandgren, Katarina

doi:10.1055/s-0032-1308698

Cited by 42 publications

(40 citation statements)

References 8 publications

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“…As a result, many paediatric surgeons began using anti-reflux medication prophylactically following OA-TOF repair. Since the initiation of this practice however, no robust evidence base has been generated to demonstrate benefit from it [15]. Our work in a population of infants with Type C OA-TOF that was heterogeneous in both its characteristics and the way that PARM was used suggests that the use of PARM does not appear to reduce the rate of stricture formation.…”

Section: Discussionmentioning

confidence: 79%

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Outcomes at One-Year Post Anastomosis from a National Cohort of Infants with Oesophageal Atresia

et al. 2014

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Background and AimsWe aimed to provide a contemporaneous assessment of outcomes at one-year post oesophageal atresia/tracheoesophageal fistula (OA-TOF) repair, focussing particularly on post-operative complications. It is generally accepted that oesophageal stricture is the most common complication and causes significant morbidity. We also aimed to assess the efficacy of prophylactic anti-reflux medication (PARM) in reducing stricture formation.MethodA prospective, multi-centre cohort study of all infants live-born with oesophageal atresia in the United Kingdom and Ireland in 2008/9 was performed, recording clinical management and outcomes at one year. The effect of PARM on stricture formation in infants with the type-c anomaly was assessed using logistic regression analysis.Results151 infants were live-born with oesophageal atresia in the defined reporting period, 126 of whom had the type-c anomaly. One-year follow-up information was returned for 105 infants (70%); the mortality rate was 8.6% (95% CI 4.7–14.3%). Post-operative complications included anastomotic leak (5.4%), recurrent fistula (3.3%) and oesophageal stricture (39%). Seventy-six (60%) of those with type-c anomaly were alive at one-year with returned follow-up, 57(75%) of whom had received PARM. Of these, 24 (42%) developed a stricture, compared to 4 (21%) of those who had not received PARM (adjusted odds ratio 2.60, 95% CI 0.71–9.46, p = 0.147).ConclusionsThis study provides a benchmark for current outcomes and complication rates following OA-TOF repair, with oesophageal stricture causing significant morbidity. The use of PARM appeared ineffective in preventing strictures. This study creates enough doubt about the efficacy of PARM in preventing stricture formation to warrant further investigation of its use with a randomised controlled trial.

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Section: Discussionmentioning

confidence: 79%

“…In our previous report on the contemporary management of OA-TOF we identified that 54% of surgeons prescribed anti-reflux medication prophylactically to prevent both GORD and stricture formation [2]. Currently however, little evidence exists to suggest that this practice reduces the stricture rate [13], [15], [16].…”

Section: Introductionmentioning

confidence: 99%

Outcomes at One-Year Post Anastomosis from a National Cohort of Infants with Oesophageal Atresia

et al. 2014

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“…Previous reports [6, 7] showed that PPIs did not affect the frequency of dilations. Prospective randomized studies are needed to determine if the use of PPIs for decreasing the risk of AS is warranted.…”

Section: Discussionmentioning

confidence: 92%

Dilations of anastomotic strictures over time after repair of esophageal atresia

et al. 2016

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Aim of the studyAnastomotic strictures commonly occur in patients undergoing surgery for esophageal atresia (EA). The primary aim of this study was to determine the age distribution of dilation procedures for anastomotic strictures over the patient’s childhood after reconstruction of EA. The secondary aim was to evaluate the effect of postoperative proton pump inhibitors (PPIs) on the frequency of dilations.MethodsThis observational study was conducted at a single tertiary center of pediatric surgery. The times that dilations of strictures were performed were assessed during three study periods: 1983–1995, 2001–2009, and 2010–2014. PPIs were not used during the first period, and then, respectively, for 3 and 12 months postoperatively. The indications for dilation were signs of obstruction and/or radiological signs of stricture.Primary resultsA total of 131 children underwent esophageal reconstruction, and of those, 60 (46%) required at least 1 dilation procedure for strictures. There were no differences in the frequencies of dilation procedures between the three study periods (28/66, 18/32 and 14/33, respectively; P = 0.42). The overall median number of dilations per patient was 3 (range 1–21) with no differences between the study periods. The differences between ages at which the first dilation was performed during each study period were significant, as follows: 7, 2, and 8 months, respectively (P = 0.03). Fiftyone percent of all dilation procedures were performed during the first year of life, 16% during the second year, and 33% during years 2–15. Four children (2%) underwent >12 dilations.ConclusionThe first year of life was the time of greatest need for dilation of AS after reconstruction of EA; however, dilations were also performed several years later. PPIs did not affect the frequency of dilations during the first year of life.

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“…[21] This was supported by the results of another study that compared EA patients on no therapy and EA patients on 3 months of postoperative PPI prophylaxis. [22] Patients who received the shorter duration of PPI prophylaxis, however, did have an earlier need for dilation.…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

“…[24] Although acid suppression has shown to be beneficial, it oftentimes cannot prevent stenosis. [22] If medical management fails, fundoplication or trans-pyloric feeds should be considered. The following groups may require fundoplication due to severe GERD not well controlled on medical therapy: those with refractory anastomotic strictures, long gap EA, persistent vomiting with failure to thrive, severe esophagitis, and extraesophageal symptoms related to GERD including cyanotic spells, repeated aspiration, and recurrent pneumonia.…”

Section: Gastroesophageal Reflux Diseasementioning

confidence: 99%

How to Care for Patients with EA-TEF: The Known and the Unknown

Mousa

Krishnan

Hassan

et al. 2017

Curr Gastroenterol Rep

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EA patients are at high risk for gastroesophageal reflux and esophageal strictures, and the sequela that result. Extraintestinal manifestations of gastroesophageal reflux disease (GERD) can appear similar to other pathologic diagnoses commonly found in EA patients, such as congenital stricture, eosinophilic esophagitis, esophageal dysmotility, tracheomalacia, recurrent fistula, aspiration, etc. Therefore, it is important to have a standardized way to monitor for these issues. pH impedance allows for detection of nonacid reflux and the height of reflux, which are important in correlating symptoms with reflux episodes. A multidisciplinary approach is beneficial in evaluating and monitoring EA patients in the long term.

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Prophylactic Treatment with Proton Pump Inhibitors in Children Operated on for Oesophageal Atresia

Cited by 42 publications

References 8 publications

Outcomes at One-Year Post Anastomosis from a National Cohort of Infants with Oesophageal Atresia

Outcomes at One-Year Post Anastomosis from a National Cohort of Infants with Oesophageal Atresia

Dilations of anastomotic strictures over time after repair of esophageal atresia

How to Care for Patients with EA-TEF: The Known and the Unknown

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