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

Autor: Ann Aspirot, Sophie Laberge, Prevost Jantchou, Christophe Faure, Franziska Righini Grunder, Laëtitia Marie Petit, Jessica Ezri
Rok vydání: 2019
Předmět:
Male
Anastomotic Leak
Constriction
Pathologic
Tracheomalacia/complications
0302 clinical medicine
Medicine
Longitudinal Studies
Postoperative Period
Child
Univariate analysis
ddc:618
medicine.diagnostic_test
Incidence (epidemiology)
Anastomosis
Surgical
Gastroenterology
Constriction
Tracheoesophageal Fistula/complications/surgery
Esophagus/surgery
Treatment Outcome
Child
Preschool
Gastroesophageal Reflux
Female
030211 gastroenterology & hepatology
Pathologic/etiology
Esophageal pH monitoring
Anastomotic Leak/etiology
Tracheoesophageal Fistula
Proton Pump Inhibitors/therapeutic use
medicine.medical_specialty
Esophageal pH Monitoring
Anastomosis
Esophageal Atresia/complications/surgery
Lansoprazole/therapeutic use
03 medical and health sciences
Esophagus
030225 pediatrics
Humans
Lansoprazole
Preschool
Esophageal Atresia
Tracheomalacia
Gastroesophageal Reflux/drug therapy/etiology
business.industry
Infant
Proton Pump Inhibitors
medicine.disease
Surgery
Discontinuation
Atresia
Pediatrics
Perinatology and Child Health
Surgical/adverse effects
Airway
business
Zdroj: Journal of Pediatric Gastroenterology and Nutrition, Vol. 69, No 1 (2019) pp. 45-51
ISSN: 1536-4801
0277-2116
Popis: 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.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 with a historical cohort of 134 EA patients followed in the same institution between 1990 and 2005 before the era of systematic PPI treatment.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% vs 39%); (P 0.05).PPI treatment does not prevent the formation of anastomotic strictures and appears to be over-prescribed in children with airway symptoms because of tracheomalacia. This suggests that PPI treatment could be prescribed more selectively. Close monitoring and long-term follow-up, however, of these vulnerable patients in specialized multidisciplinary clinics is imperative.
Databáze: OpenAIRE
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