title: The management of postoperative reflux in congenital esophageal atresia-tracheoesophageal fistula: a systematic review.
abstract: OBJECTIVE
  Esophageal atresia (EA), with or without tracheoesophageal fistula (TEF), is associated with postoperative gastroesophageal reflux (GER). We performed a systematic review of the literature regarding routine anti-reflux medication post EA-TEF repair and its impact on postoperative GER and associated complications.
  
  
  METHODS
  A comprehensive search was conducted using MEDLINE, EMBASE, CINHAL, CENTRAL (Cochrane library) electronic databases and gray literature. Full-text screening was performed in duplicate. Included articles reported a primary diagnosis of EA-TEF, a secondary diagnosis of postoperative GER, and primary treatment of GER with anti-reflux medications.
  
  
  RESULTS
  Screening of 2,910 articles resulted in 25 articles (1,663 patients) for analysis. Most were single-center studies (92%) and retrospective (76%); there were no randomized control trials. Fifteen studies named the class of anti-reflux agent used, 3 the duration of therapy, and none either the dose prescribed or number of doses. Complications were inconsistently reported. Anti-reflux surgery was performed in 433/1,663 (26.0%) patients. Average follow-up was 53.2 months (14 studies).
  
  
  CONCLUSIONS
  The quality of literature regarding anti-reflux medication for GER post EA-TEF repair is poor. There are no well-outlined algorithms for anti-reflux agents, doses, or duration of therapy. Standardized protocols and reliable reporting are necessary to develop guidelines to better manage postoperative GER in EA-TEF patients.
authors.affiliation: Department of Pediatric Surgery, McMaster Children's Hospital, Hamilton, ON, Canada, annashawyer@gmail.com.
authors.forename: Anna C
authors.initials: AC
authors.lastname: Shawyer
authors.forename: Joanne
authors.initials: J
authors.lastname: D'Souza
authors.forename: Julia
authors.initials: J
authors.lastname: Pemberton
authors.forename: Helene
authors.initials: H
authors.lastname: Flageole
mesh_terms: D003680:Deglutition Disorders / Q000150:complications; D004933:Esophageal Atresia; D004940:Esophageal Stenosis / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D005764:Gastroesophageal Reflux / Q000150:complications / Q000517:prevention & control / Q000601:surgery*; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011014:Pneumonia / Q000150:complications; D011183:Postoperative Complications / Q000517:prevention & control / Q000601:surgery*; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012008:Recurrence; D014138:Tracheoesophageal Fistula / Q000150:complications / Q000151:congenital* / Q000601:surgery*; D016896:Treatment Outcome
chemical_list: D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors