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Should Proton Pump Inhibitors be Systematically Prescribed in Patients with Esophageal Atresia After Surgical Repair?

Grunder, Franziska Righini*; Petit, Laetitia-Marie*,||; Ezri, Jessica*,¶; Jantchou, Prevost*; Aspirot, Ann‡,§; Laberge, Sophie†,§; Faure, Christophe*,§

Journal of Pediatric Gastroenterology and Nutrition: March 5, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002328
Original Article: Gastroenterology: PDF Only
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Objective: To evaluate outcomes of patients with esophageal atresia (EA) on systematic treatment with proton pump inhibitors (PPI) since the neonatal period and to determine factors associated with successful discontinuation of PPI.

Study design: Longitudinal cohort study with prospective data collection of 73 EA patients, over 11 years systematically treated with PPI. Outcome and predictive factors for discontinuation of PPI treatment were evaluated at study end in February 2017. The incidence of anastomotic strictures was compared to a historical cohort of 134 EA patients followed in the same institution between 1990 and 2005 before the era of systematic PPI treatment.

Results: PPI treatment was discontinued definitively in 48% of patients during follow up. Prematurity, longer initial hospitalization, moderate to severe tracheomalacia, anastomotic leak and anastomotic stricture had a significant negative association with PPI discontinuation on univariate analysis (p < 0.05). On adjusted multivariable Cox regression analysis, moderate to severe tracheomalacia and anastomotic leak were negatively associated with discontinuation of PPI treatment (hazard ratio 0.26 [95% CI 0.12-0.59]; p = 0.001 and hazard ratio 0.38 [95% CI 0.16–0.93]; p = 0.03 respectively). There was no significant difference in the incidence of anastomotic strictures in the present cohort compared with the historical cohort (44% versus 39%); p > 0.05).

Conclusion: PPI treatment does not prevent the formation of anastomotic strictures and appears to be over-prescribed in children with airway symptoms due to tracheomalacia. This suggests that PPI treatment could be prescribed more selectively. However, close monitoring and long-term follow-up of these vulnerable patients in specialized multidisciplinary clinics is imperative.

*Division of Pediatric Gastroenterology Hepatology and Nutrition, CHU Sainte-Justine, Université de Montréal, Montréal, Canada

Division of Pediatric Pulmonology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada

Division of Pediatric Surgery, CHU Sainte-Justine, Université de Montréal, Montréal, Canada

§Esophageal Atresia Clinic, CHU Sainte-Justine, Université de Montréal, Montréal, Canada

||Division of Pediatric Gastroenterology Hepatology and Nutrition, HUG,, Université de Genève, Genève, Switzerland

Division of Pediatric Gastroenterology Hepatology and Nutrition, CHUV,, Université de Lausanne, Lausanne, Switzerland.

Address correspondence and reprint requests to Franziska Righini Grunder, and Christophe Faure, Division of Pediatric Gastroenterology, Sainte-Justine Hospital, 3715 Côte Sainte Catherine, H3T1C5, Montreal, Qc, Canada (e-mail: franziskarighini@gmail.com) (christophe.faure@umontreal.ca).

Received 9 August, 2018

Accepted 13 February, 2019

Author Contribution:

Study concept and design: Righini Grunder, Petit, Ezri, Faure

Data acquisition: Righini Grunder, Petit, Ezri

Data analyses: Righini Grunder, Petit, Faure

Drafting of the manuscript: Righini Grunder, Faure

Critical revision of the manuscript for important intellectual content: All authors

Statistical analysis: Righini Grunder, Jantchou

Administrative, technical and material support: Righini Grunder, Faure

Study supervisor: Faure

Source of funding: None

Conflict of interest disclosures: The authors have no conflict of interest.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal's Web site (www.jpgn.org).

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,