Suhail Zeineddin, Gwyneth A Sullivan, J Benjamin Pitt, Michela Carter, Seth D Goldstein, Brian C Gulack
{"title":"Acid suppression after esophageal atresia repair: Some infants do benefit.","authors":"Suhail Zeineddin, Gwyneth A Sullivan, J Benjamin Pitt, Michela Carter, Seth D Goldstein, Brian C Gulack","doi":"10.1002/jpn3.70173","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Acid suppression is used to protect against anastomotic strictures after esophageal atresia/tracheoesophageal fistula (EA/TEF) repair, but recent studies have contested this benefit. We aimed to compare rates of anastomotic stricture following EA/TEF repair among patients who received and did not receive acid suppression in a nationwide sample.</p><p><strong>Methods: </strong>We queried the Pediatric Health Information System for infants undergoing EA/TEF repair between 2010 and 2022. Acid suppression was defined as receipt of an H2 blocker or proton pump inhibitor on the day of discharge or longer than 30 inpatient days. Complex EA/TEF repair was defined as delayed repair (>7 days), G-tube placement before repair, prolonged hospitalization (>60 days), or multiple inpatient fluoroscopies. Stricture dilation defined the outcome.</p><p><strong>Results: </strong>Of 1445 infants included from 47 hospitals, 257 (17.8%) required dilation by 1 year. Of the 688 (47.6%) infants who met criteria for complex EA/TEF, 126 (18.6%) required a dilation. Prolonged acid suppression was given in 977 (67.6%) infants. At 1 year, stricture rate was similar in infants with simple EA/TEF, with or without acid suppression (17.5% vs. 17.0%, p = 0.90), however, in infants with complex EA/TEF, stricture rates were lower among those who received acid suppression compared to those who did not (15.3% vs. 26.0%, p = 0.001).</p><p><strong>Conclusion: </strong>In patients with complex EA/TEF, those who received postoperative acid suppression had a lower incidence of stricture. While it is reasonable to reduce the use of acid suppression after simple EA/TEF repair, infants with complex EA/TEF should receive acid suppression to reduce the risk of stricture.</p>","PeriodicalId":16694,"journal":{"name":"Journal of Pediatric Gastroenterology and Nutrition","volume":" ","pages":"960-966"},"PeriodicalIF":2.6000,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Pediatric Gastroenterology and Nutrition","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/jpn3.70173","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/8/5 0:00:00","PubModel":"Epub","JCR":"Q3","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Acid suppression is used to protect against anastomotic strictures after esophageal atresia/tracheoesophageal fistula (EA/TEF) repair, but recent studies have contested this benefit. We aimed to compare rates of anastomotic stricture following EA/TEF repair among patients who received and did not receive acid suppression in a nationwide sample.
Methods: We queried the Pediatric Health Information System for infants undergoing EA/TEF repair between 2010 and 2022. Acid suppression was defined as receipt of an H2 blocker or proton pump inhibitor on the day of discharge or longer than 30 inpatient days. Complex EA/TEF repair was defined as delayed repair (>7 days), G-tube placement before repair, prolonged hospitalization (>60 days), or multiple inpatient fluoroscopies. Stricture dilation defined the outcome.
Results: Of 1445 infants included from 47 hospitals, 257 (17.8%) required dilation by 1 year. Of the 688 (47.6%) infants who met criteria for complex EA/TEF, 126 (18.6%) required a dilation. Prolonged acid suppression was given in 977 (67.6%) infants. At 1 year, stricture rate was similar in infants with simple EA/TEF, with or without acid suppression (17.5% vs. 17.0%, p = 0.90), however, in infants with complex EA/TEF, stricture rates were lower among those who received acid suppression compared to those who did not (15.3% vs. 26.0%, p = 0.001).
Conclusion: In patients with complex EA/TEF, those who received postoperative acid suppression had a lower incidence of stricture. While it is reasonable to reduce the use of acid suppression after simple EA/TEF repair, infants with complex EA/TEF should receive acid suppression to reduce the risk of stricture.
背景：抑酸用于防止食管闭锁/气管食管瘘（EA/TEF）修复后吻合口狭窄，但最近的研究对这种益处提出了质疑。我们的目的是比较全国范围内接受和未接受抑酸治疗的患者在EA/TEF修复后吻合口狭窄的发生率。方法：我们查询2010年至2022年间接受EA/TEF修复的婴儿儿科健康信息系统。酸抑制被定义为在出院当天或住院时间超过30天时接受H2阻滞剂或质子泵抑制剂。复杂EA/TEF修复定义为延迟修复（>7天）、修复前放置g管、延长住院时间（>60天）或多次住院透视。狭窄扩张决定了结果。结果：来自47家医院的1445名婴儿中，257名（17.8%）在1岁前需要扩张。在688例（47.6%）符合复杂EA/TEF标准的婴儿中，126例（18.6%）需要扩张术。977例（67.6%）患儿接受长时间抑酸治疗。1年时，单纯EA/TEF患儿的狭窄率与是否抑酸相似（17.5% vs. 17.0%, p = 0.90），然而，在复杂EA/TEF患儿中，接受抑酸治疗的狭窄率低于未接受抑酸治疗的婴儿（15.3% vs. 26.0%, p = 0.001）。结论：在复杂EA/TEF患者中，术后抑酸组狭窄发生率较低。单纯EA/TEF修复后减少抑酸治疗是合理的，但复杂EA/TEF患儿应接受抑酸治疗，以降低狭窄风险。
期刊介绍：
The Journal of Pediatric Gastroenterology and Nutrition (JPGN) provides a forum for original papers and reviews dealing with pediatric gastroenterology and nutrition, including normal and abnormal functions of the alimentary tract and its associated organs, including the salivary glands, pancreas, gallbladder, and liver. Particular emphasis is on development and its relation to infant and childhood nutrition.
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号
