Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

Prevalence of acid gastroesophageal reflux disease in infants with esophageal atresia/tracheoesophageal fistula

Abstract

Background

Given the high prevalence and complication risks of acid gastroesophageal reflux (GERD) in the first months of life in infants with esophageal atresia, the ESPGHAN/NASPGHAN consensus statement recommends systematic treatment with proton pump inhibitors (PPIs) until the age of 1 year and checking for acid GERD thereafter. However, these recommendations have not been evaluated.

Methods

This prospective study was conducted from 2007 to 2016. We evaluated the prevalence of acid GERD in 100 consecutive infants presenting with esophageal atresia/tracheoesophageal fistula after the age of 18 months when PPI treatment was stopped. The diagnosis of acid GERD was based on positive pH-metry and/or evidence of complications (e.g., peptic esophagitis, need for jejunal nutrition, or antireflux surgery). Those with acid GERD at a median age of 18 months received a control examination every year or adapted to their clinical situation.

Results

The prevalence rates of acid GERD were 64.3% at 18 months and 22.8% at the last follow-up (median age 65 months).There is no risk factor for acid GERD identified.

Conclusions

This study shows a high prevalence of acid GERD in late infancy and supports the recommendation of systematic checking for acid GERD when treatment with PPI is stopped.

Impact

  • Acid gastroesophageal reflux disease (GERD) is a frequent complication of esophageal atresia in infants. The ESPGHAN/NASPGHAN consensus, which is based on expert opinion, recommends systematic treatment of children with PPI until the age of 1 year.

  • The prevalence rates of acid GERD were 64.3% at 18 months and 22.8% at the last follow-up. This study shows a high prevalence of acid GERD in late infancy and supports the recommendation of systematic checking for acid GERD when treatment with PPI is stopped.

Access options

Rent or Buy article

Get time limited or full article access on ReadCube.

from$8.99

All prices are NET prices.

Fig. 1
Fig. 2

References

  1. 1.

    Sfeir, R., Michaud, L., Salleron, J. & Gottrand, F. Epidemiology of esophageal atresia. Dis. Esophagus 26, 354–355 (2013).

    CAS  Article  Google Scholar 

  2. 2.

    Nassar, N. et al. Prevalence of esophageal atresia among 18 international birth defects surveillance programs. Birth Defects Res. A Clin. Mol. Teratol. 94, 893–899 (2012).

    CAS  Article  Google Scholar 

  3. 3.

    Goyal, A., Jones, M. O., Couriel, J. M. & Losty, P. D. Oesophageal atresia and tracheo-oesophageal fistula. Arch. Dis. Child Fetal Neonatal Ed. 91, F381–F384 (2006).

    CAS  Article  Google Scholar 

  4. 4.

    Montgomery, M. & Frenckner, B. Esophageal atresia: mortality and complications related to gastroesophageal reflux. Eur. J. Pediatr. Surg. 3, 335–338 (1993).

    CAS  Article  Google Scholar 

  5. 5.

    Legrand, C. et al. Long-term outcome of children with oesophageal atresia type III. Arch. Dis. Child. 97, 808–811 (2012).

    Article  Google Scholar 

  6. 6.

    Martigne, L. et al. Prevalence and management of gastroesophageal reflux disease in children and adolescents: a nationwide cross-sectional observational study. Eur. J. Pediatr. 171, 1767–1773 (2012).

    Article  Google Scholar 

  7. 7.

    Deurloo, J. A., Ekkelkamp, S., Schoorl, M., Heij, H. A. & Aronson, D. C. Esophageal atresia: historical evolution of management and results in 371 patients. Ann. Thorac. Surg. 73, 267–272 (2002).

    Article  Google Scholar 

  8. 8.

    Little, D. C. et al. Long-term analysis of children with esophageal atresia and tracheoesophageal fistula. J. Pediatr. Surg. 38, 852–856 (2003).

    CAS  Article  Google Scholar 

  9. 9.

    Somppi, E. et al. Outcome of patients operated on for esophageal atresia: 30 years’ experience. J. Pediatr. Surg. 33, 1341–1346 (1998).

    CAS  Article  Google Scholar 

  10. 10.

    Hameeteman, W., Tytgat, G. N., Houthoff, H. J. & van den Tweel, J. G. Barrett’s esophagus: development of dysplasia and adenocarcinoma. Gastroenterology 96, 1249–1256 (1989).

    CAS  Article  Google Scholar 

  11. 11.

    Schneider, A. et al. Prevalence of Barrett esophagus in adolescents and young adults with esophageal atresia. Ann. Surg. 264, 1004–1008 (2016).

    Article  Google Scholar 

  12. 12.

    Shawyer, A. C., Pemberton, J., Kanters, D., Alnaqi, A. A. A. & Flageole, H. Quality of reporting of the literature on gastrointestinal reflux after repair of esophageal atresia-tracheoesophageal fistula. J. Pediatr. Surg. 50, 1099–1103 (2015).

    Article  Google Scholar 

  13. 13.

    Centre de référence des affections chroniques et malformatives de l'oesophage (CRACMO) et Filière nationale des maladies rares abdominothoraciques (FIMATHO), Protocole Nationale de Diagnostic et de Soins, Atrésie de l'oesophage, 2018. Available from: https://www.has-sante.fr/upload/docs/application/pdf/2018-12/20181212_pnds_atresie_de_loesophage_dec_2018_vf_charte.pdf.

  14. 14.

    Krishnan, U. et al. ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula. J. Pediatr. Gastroenterol. Nutr. 63, 550–570 (2016).

    Article  Google Scholar 

  15. 15.

    Ladd, W. E., Swenson, O. & Esophageal Atresia and tracheo-esophageal fistula. Ann. Surg. 125, 23–40 (1947).

    CAS  Article  Google Scholar 

  16. 16.

    Dingemann, C. et al. ERNICA Consensus Conference on the Management of Patients with Long-Gap Esophageal Atresia: Perioperative, Surgical, and Long-Term Management. Eur. J. Pediatr. Surg. 30, 326–336 (2020).

    Article  Google Scholar 

  17. 17.

    François, B. et al. Predictors of the performance of early antireflux surgery in esophageal atresia. J. Pediatr. 211, 120.e1–125.e1 (2019).

  18. 18.

    Vandenplas, Y. et al. Pediatric gastroesophageal reflux clinical practice guidelines: joint recommendations of the North American Society for Pediatric Gastroenterology, Hepatology, and Nutrition (NASPGHAN) and the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN). J. Pediatr. Gastroenterol. Nutr. 49, 498–547 (2009).

    Article  Google Scholar 

  19. 19.

    Prentice, R. L. et al. The analysis of failure times in the presence of competing risks. Biometrics 34, 541–554 (1978).

    CAS  Article  Google Scholar 

  20. 20.

    Castilloux, J., Noble, A. J. & Faure, C. Risk factors for short- and long-term morbidity in children with esophageal atresia. J. Pediatr. 156, 755–760 (2010).

    Article  Google Scholar 

  21. 21.

    Catalano, P., Di Pace, M. R., Caruso, A. M., Casuccio, A. & De Grazia, E. Gastroesophageal reflux in young children treated for esophageal atresia: evaluation with pH-multichannel intraluminal impedance. J. Pediatr. Gastroenterol. Nutr. 52, 686–690 (2011).

    Article  Google Scholar 

  22. 22.

    Vergouwe, F. W. T. et al. Evaluation of gastroesophageal reflux in children born with esophageal atresia using pH and impedance monitoring. J. Pediatr. Gastroenterol. Nutr. 69, 515–522 (2019).

  23. 23.

    Righini Grunder, F. et al. Should proton pump inhibitors be systematically prescribed in patients with esophageal atresia after surgical repair? J. Pediatr. Gastroenterol. Nutr. 69, 45–51 (2019).

    CAS  Article  Google Scholar 

  24. 24.

    Koivusalo, A., Pakarinen, M. P. & Rintala, R. J. 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. 42, 370–374 (2007).

    Article  Google Scholar 

  25. 25.

    Nakazato, Y., Landing, B. H. & Wells, T. R. Abnormal Auerbach plexus in the esophagus and stomach of patients with esophageal atresia and tracheoesophageal fistula. J. Pediatr. Surg. 21, 831–837 (1986).

    CAS  Article  Google Scholar 

  26. 26.

    Gottrand, M., Michaud, L., Sfeir, R. & Gottrand, F. Motility, digestive and nutritional problems in esophageal atresia. Paediatr. Respir. Rev. 19, 28–33 (2016).

    PubMed  Google Scholar 

  27. 27.

    Bardou, M., Fortinsky, K. J., Chapelle, N., Luu, M. & Barkun, A. An update on the latest chemical therapies for reflux esophagitis in children. Expert Opin. Pharmacother. 20, 231–239 (2019).

    CAS  Article  Google Scholar 

  28. 28.

    Schneider, A. et al. Results from the French National Esophageal Atresia register: one-year outcome. Orphanet J. Rare Dis. 9, 206 (2014).

    Article  Google Scholar 

  29. 29.

    Koumbourlis, A. C. et al. Care recommendations for the respiratory complications of esophageal atresia-tracheoesophageal fistula. Pediatr. Pulmonol. 55, 2713–2729 (2020).

    Article  Google Scholar 

  30. 30.

    Chang, T.-H. et al. Increased age and proton pump inhibitors are associated with severe Clostridium difficile infections in children. J. Microbiol Immunol. Infect. 53, 578–584 (2020).

    CAS  Article  Google Scholar 

  31. 31.

    Poddar, U. Gastroesophageal reflux disease (GERD) in children. Paediatr. Int. Child Health 39, 7–12 (2019).

    Article  Google Scholar 

  32. 32.

    De Bruyne, P. & Ito, S. Toxicity of long-term use of proton pump inhibitors in children. Arch. Dis. Child. 103, 78–82 (2018).

    Article  Google Scholar 

  33. 33.

    Miyake, H. et al. Are prophylactic anti-reflux medications effective after esophageal atresia repair? Systematic review and meta-analysis. Pediatr. Surg. Int. 34, 491–497 (2018).

    Article  Google Scholar 

Download references

Acknowledgements

In memory of Dr. L Michaud, who inspired this study.

Author information

Affiliations

Authors

Contributions

C.F. and F.G. contributed to conception and design, acquisition of data, analysis and interpretation of data, drafting the article, and final approval of the version to be published. M.A. contributed to conception and design and final approval of the version to be published. D.L., R.S., A.N., and M.B. contributed to final approval of the version to be published. A.D. contributed to analysis and interpretation of data.

Corresponding author

Correspondence to Charlotte Flatrès.

Ethics declarations

Competing interests

The authors declare no competing interests.

Consent statement

Data were collected from a population-based registry of esophageal atresia, which began collecting data prospectively on all infants born with esophageal atresia in France from January 1, 2007. The registry was approved by the National Informatics and Privacy Committee and was qualified by the National Committee of Register. All data were used anonymously, and the parents were informed of the aims of the registry.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary information

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Flatrès, C., Aumar, M., Ley, D. et al. Prevalence of acid gastroesophageal reflux disease in infants with esophageal atresia/tracheoesophageal fistula. Pediatr Res (2021). https://doi.org/10.1038/s41390-021-01510-w

Download citation

Search

Quick links