Flatrès Charlotte, Aumar Madeleine, Ley Delphine, Sfeir Rony, Nicolas Audrey, Bonnevalle Michel, Duhamel Alain, Gottrand Frédéric
Pediatric Department, CHRU Brest, Brest, France.
Univ. Lille, CHU Lille, INSERM U1286, Reference Center for Congenital Abnormalities of the Esophagus, Lille, France.
Pediatr Res. 2022 Mar;91(4):977-983. doi: 10.1038/s41390-021-01510-w. Epub 2021 Apr 16.
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.
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.
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.
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.
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.
鉴于食管闭锁婴儿出生后头几个月胃酸胃食管反流（GERD）的高患病率和并发症风险，欧洲儿科胃肠病、肝病和营养学会（ESPGHAN）/北美儿科胃肠病、肝病和营养学会（NASPGHAN）共识声明建议用质子泵抑制剂（PPI）进行系统性治疗至1岁，之后检查是否存在胃酸GERD。然而，这些建议尚未得到评估。
这项前瞻性研究于2007年至2016年进行。我们评估了100例连续出现食管闭锁/气管食管瘘且在18个月龄停止PPI治疗后的婴儿中胃酸GERD的患病率。胃酸GERD的诊断基于pH测定阳性和/或并发症证据（如消化性食管炎、空肠营养需求或抗反流手术）。那些在18个月龄时患有胃酸GERD的婴儿每年接受一次对照检查或根据其临床情况进行调整。
胃酸GERD的患病率在18个月时为64.3%，在最后一次随访（中位年龄65个月）时为22.8%。未发现胃酸GERD的危险因素。
本研究显示婴儿晚期胃酸GERD的患病率很高，并支持在停止PPI治疗时系统性检查胃酸GERD的建议。
胃酸胃食管反流病（GERD）是婴儿食管闭锁的常见并发症。基于专家意见的ESPGHAN/NASPGHAN共识建议对儿童用PPI进行系统性治疗至1岁。胃酸GERD的患病率在18个月时为64.3%，在最后一次随访时为22.8%。本研究显示婴儿晚期胃酸GERD的患病率很高，并支持在停止PPI治疗时系统性检查胃酸GERD的建议。
