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Acid suppression after esophageal atresia repair: Some infants do benefit

Suhail Zeineddin1,2, Gwyneth A Sullivan1,2,3, J Benjamin Pitt1,2

  • 1Division of Pediatric Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA.

Journal of Pediatric Gastroenterology and Nutrition
|August 5, 2025
PubMed

Insights

Acid suppression therapy may reduce stricture rates in infants undergoing complex esophageal atresia/tracheoesophageal fistula (EA/TEF) repair. For simple EA/TEF cases, acid suppression showed no significant benefit in preventing anastomotic strictures.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Neonatal Care

Background:

  • Acid suppression is commonly used post-esophageal atresia/tracheoesophageal fistula (EA/TEF) repair to prevent anastomotic strictures.
  • Recent evidence has questioned the efficacy of acid suppression in this context.
  • This study investigates the association between acid suppression and stricture rates in a large infant cohort.

Purpose of the Study:

  • To compare anastomotic stricture rates in infants undergoing EA/TEF repair with and without acid suppression.
  • To determine if acid suppression is beneficial for preventing strictures in simple versus complex EA/TEF cases.

Main Methods:

  • A nationwide sample of infants undergoing EA/TEF repair (2010-2022) was analyzed using the Pediatric Health Information System.
  • Acid suppression was defined by H2 blocker or PPI use.
  • Complex EA/TEF repair included criteria like delayed repair, G-tube placement, prolonged hospitalization, or multiple fluoroscopies. Stricture dilation was the primary outcome.

Main Results:

  • Among 1445 infants, 17.8% required dilation by 1 year.
  • For simple EA/TEF, stricture rates were similar with or without acid suppression (17.5% vs. 17.0%, p=0.90).
  • In complex EA/TEF cases, those receiving acid suppression had significantly lower stricture rates (15.3% vs. 26.0%, p=0.001).

Conclusions:

  • Postoperative acid suppression is associated with reduced stricture incidence in complex EA/TEF repair.
  • Reducing acid suppression may be appropriate for simple EA/TEF repairs.
  • Acid suppression should be considered for infants with complex EA/TEF to mitigate stricture risk.
Abstract

Keywords:
PPITEFstricturetracheoesophageal fistula

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