PMID- 30889131
OWN - NLM
STAT- MEDLINE
DCOM- 20200915
LR  - 20200915
IS  - 1536-4801 (Electronic)
IS  - 0277-2116 (Linking)
VI  - 69
IP  - 1
DP  - 2019 Jul
TI  - Should Proton Pump Inhibitors be Systematically Prescribed in Patients With 
      Esophageal Atresia After Surgical Repair?
PG  - 45-51
LID - 10.1097/MPG.0000000000002328 [doi]
AB  - OBJECTIVE: 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. STUDY 
      DESIGN: 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. RESULTS: 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). CONCLUSIONS: 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.
FAU - Righini Grunder, Franziska
AU  - Righini Grunder F
AD  - Division of Pediatric Gastroenterology Hepatology and Nutrition.
FAU - Petit, Laetitia-Marie
AU  - Petit LM
AD  - Division of Pediatric Gastroenterology Hepatology and Nutrition.
AD  - Division of Pediatric Gastroenterology Hepatology and Nutrition, HUG, Universite 
      de Geneve, Geneve.
FAU - Ezri, Jessica
AU  - Ezri J
AD  - Division of Pediatric Gastroenterology Hepatology and Nutrition.
AD  - Division of Pediatric Gastroenterology Hepatology and Nutrition, CHUV, Universite 
      de Lausanne, Lausanne, Switzerland.
FAU - Jantchou, Prevost
AU  - Jantchou P
AD  - Division of Pediatric Gastroenterology Hepatology and Nutrition.
FAU - Aspirot, Ann
AU  - Aspirot A
AD  - Division of Pediatric Surgery.
AD  - Esophageal Atresia Clinic, CHU Sainte-Justine, Universite de Montreal, Montreal, 
      Canada.
FAU - Laberge, Sophie
AU  - Laberge S
AD  - Division of Pediatric Pulmonology.
AD  - Esophageal Atresia Clinic, CHU Sainte-Justine, Universite de Montreal, Montreal, 
      Canada.
FAU - Faure, Christophe
AU  - Faure C
AD  - Division of Pediatric Gastroenterology Hepatology and Nutrition.
AD  - Esophageal Atresia Clinic, CHU Sainte-Justine, Universite de Montreal, Montreal, 
      Canada.
LA  - eng
PT  - Journal Article
PL  - United States
TA  - J Pediatr Gastroenterol Nutr
JT  - Journal of pediatric gastroenterology and nutrition
JID - 8211545
RN  - 0 (Proton Pump Inhibitors)
RN  - 0K5C5T2QPG (Lansoprazole)
RN  - Congenital tracheomalacia
RN  - Esophageal atresia with or without tracheoesophageal fistula
SB  - IM
MH  - Anastomosis, Surgical/adverse effects
MH  - Anastomotic Leak/etiology
MH  - Child
MH  - Child, Preschool
MH  - Constriction, Pathologic/etiology
MH  - Esophageal Atresia/complications/*surgery
MH  - Esophageal pH Monitoring
MH  - Esophagus/*surgery
MH  - Female
MH  - Gastroesophageal Reflux/*drug therapy/etiology
MH  - Humans
MH  - Infant
MH  - Lansoprazole/*therapeutic use
MH  - Longitudinal Studies
MH  - Male
MH  - Postoperative Period
MH  - Proton Pump Inhibitors/*therapeutic use
MH  - Tracheoesophageal Fistula/complications/*surgery
MH  - Tracheomalacia/complications
MH  - Treatment Outcome
EDAT- 2019/03/20 06:00
MHDA- 2020/09/17 06:00
CRDT- 2019/03/20 06:00
PHST- 2019/03/20 06:00 [pubmed]
PHST- 2020/09/17 06:00 [medline]
PHST- 2019/03/20 06:00 [entrez]
AID - 10.1097/MPG.0000000000002328 [doi]
PST - ppublish
SO  - J Pediatr Gastroenterol Nutr. 2019 Jul;69(1):45-51. doi: 
      10.1097/MPG.0000000000002328.