Shawyer Anna C, D'Souza Joanne, Pemberton Julia, Flageole Helene
Department of Pediatric Surgery, McMaster Children's Hospital, Hamilton, ON, Canada,
Pediatr Surg Int. 2014 Oct;30(10):987-96. doi: 10.1007/s00383-014-3548-0. Epub 2014 Jul 11.
Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with postoperative gastroesophageal reflux (GER). We performed a systematic review of the literature regarding routine anti-reflux medication post EA-TEF repair and its impact on postoperative GER and associated complications.
A comprehensive search was conducted using MEDLINE, EMBASE, CINHAL, CENTRAL (Cochrane library) electronic databases and gray literature. Full-text screening was performed in duplicate. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with anti-reflux medications.
Screening of 2,910 articles resulted in 25 articles (1,663 patients) for analysis. Most were single-center studies (92%) and retrospective (76%); there were no randomized control trials. Fifteen studies named the class of anti-reflux agent used, 3 the duration of therapy, and none either the dose prescribed or number of doses. Complications were inconsistently reported. Anti-reflux surgery was performed in 433/1,663 (26.0%) patients. Average follow-up was 53.2 months (14 studies).
The quality of literature regarding anti-reflux medication for GER post EA-TEF repair is poor. There are no well-outlined algorithms for anti-reflux agents, doses, or duration of therapy. Standardized protocols and reliable reporting are necessary to develop guidelines to better manage postoperative GER in EA-TEF patients.
食管闭锁（EA）伴或不伴气管食管瘘（TEF）与术后胃食管反流（GER）相关。我们对关于EA - TEF修复术后常规抗反流药物治疗及其对术后GER和相关并发症影响的文献进行了系统综述。
使用MEDLINE、EMBASE、CINHAL、CENTRAL（Cochrane图书馆）电子数据库和灰色文献进行全面检索。全文筛选由两人独立进行。纳入的文章报告了EA - TEF的初步诊断、术后GER的二次诊断以及使用抗反流药物对GER的主要治疗。
对2910篇文章进行筛选后，有25篇文章（1663例患者）可供分析。大多数是单中心研究（92%）且为回顾性研究（76%）；没有随机对照试验。15项研究提到了所使用的抗反流药物类别，3项研究提到了治疗持续时间，但均未提及规定剂量或给药次数。并发症的报告不一致。433/1663（26.0%）例患者接受了抗反流手术。平均随访时间为53.2个月（14项研究）。
关于EA - TEF修复术后GER抗反流药物治疗的文献质量较差。对于抗反流药物、剂量或治疗持续时间，没有明确的算法。需要标准化方案和可靠的报告来制定指南，以更好地管理EA - TEF患者术后的GER。
