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Updated: Jan 7, 2026
Simultaneous Laryngopharyngeal and Conventional Esophageal pH Monitoring
Published on: December 14, 2020
Gastro-Esophageal Reflux in Esophageal Atresia Patients Remains a Challenge: Results from a Systematic Review and
Alexander Sterlin1,2, Hanna Garnier3,4, Gabriela Vallejo5,6
1Department of Pediatric Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany.
Insights
Gastroesophageal reflux disease (GERD) affects over a third of patients after esophageal atresia (EA) repair, often requiring anti-reflux surgery (ARS). Complications from ARS are higher in infants, indicating a need for standardized GERD management in EA patients.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Clinical Research
Background:
- Esophageal atresia (EA) repair is a complex procedure with ongoing challenges in managing associated gastroesophageal reflux disease (GERD).
- Current management strategies for GERD post-EA repair lack standardization, leading to controversial treatment approaches.
- Optimizing GERD management is crucial for improving long-term outcomes in children with a history of EA.
Purpose of the Study:
- To systematically review and meta-analyze the current management of GERD in children following EA repair.
- To determine the prevalence of GERD in this population and evaluate the effectiveness of medical and surgical therapies.
- To identify factors influencing GERD management and outcomes after EA repair.
Main Methods:
- A systematic review and meta-analysis adhering to PRISMA 2020 guidelines.
- Comprehensive literature search across MEDLINE, Cochrane Database, and Web of Science for studies on GERD in patients under 18 with prior EA repair.
- Data extraction focused on GERD incidence, diagnostic methods, medical/surgical interventions, and patient outcomes.
Main Results:
- The pooled incidence of GERD was 36.7% overall, rising to 58.1% in type A/B EA.
- While 88% received proton pump inhibitors, 53.8% required further interventions, including anti-reflux surgery (ARS).
- ARS success was 74.5%, but complications occurred in 28.3%, with higher rates in infants <6 months; redo fundoplication was needed in 14.9%.
Conclusions:
- GERD is highly prevalent post-EA repair, particularly in types A/B, often necessitating ARS.
- Medical management alone is frequently insufficient, and ARS in infants carries significant complication risks.
- Standardized diagnostic criteria and prospective, multicenter registries are essential for optimizing ARS timing and techniques in EA patients.
Abstract:
Although international guidelines address the management of esophageal atresia (EA), the optimal approach to gastroesophageal reflux disease (GERD) in this population remains controversial. This systematic review and meta-analysis aims to clarify the current management of GERD in children after EA repair, reporting the prevalence of GERD, indications, and effectiveness of medical and surgical therapies.A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A literature search was performed in MEDLINE, Cochrane Database, and Web of Science. Studies involving patients under 18 years old with GERD following EA repair were included. Data were extracted on incidence, diagnostic approach, medical and surgical management, and outcomes.Out of 1,612 articles, 49 (5,613 patients) were included. Reporting diagnostic modality, pH-impedance was most frequently used. The pooled GERD incidence was 36.7% overall and 58.1% in type A/B EA. Postoperative anti-reflux medication was reported in 88% of patients; 53.8% of children receiving medical therapy subsequently required further procedures (anti-reflux surgery [ARS], feeding stoma, or total esophago-gastric dissociation). ARS was more common in type A/B than in type C/D cohorts. Resolution of symptoms after ARS was reported in 74.5% of patients. Complications following ARS occurred in 28.3%, with a 14.9% rate of redo fundoplication, and the highest incidence occurred in infants < 6 months. The data on timing and type of ARS were heterogeneous.GERD affected over one-third of EA patients, with higher prevalence in types A and B. Although proton pump inhibitor therapy is common, a large proportion required ARS, with higher complication rates in smaller children. These findings highlight the need for standardized diagnostic criteria and multicenter prospective registries with long-term follow-up to clarify optimal timing and technique.
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