Association between administration of antacid medication and anastomotic stricture formation following repair of oesophageal atresia

Abstract

Aims of study: Anastomotic stricture is a significant cause of morbidity following repair of oesophageal atresia (OA). Exposure to gastric acid has been postulated to contribute to stricture development and severity leading to prophylactic antacid use by some surgeons. We investigated the association between administration of antacid medication and the development of anastomotic strictures.

Methods: Retrospective case-note review of consecutive infants undergoing repair of OA with distal tracheoesophageal fistula (Type C) between Jan 1994 and Dec 2014. Only infants who underwent primary oesophageal anastomosis at initial surgical procedure were included. Stricture related outcomes were compared initially for infants who received prophylactic antacid medication versus no prophylaxis, and the role of prophylactic antacid medication in stricture prevention was explored in a multivariate model. Outcomes were also compared for infants grouped by antacid use at any stage.

Results: One hundred fourteen infants were included. Sixteen received prophylactic antacid medication at surgeon preference. Of the remaining 98, 44 subsequently received antacid as treatment for gastro-oesophageal reflux (GOR) and 54 never received antacid medication. There was no statistically significant association between incidence of stricture in the first year (10/16 vs 41/98; p=0.18) nor time to first stricture (median 57 days [41-268] vs 102 days [43-320]; p=0.89) and administration of prophylactic antacid medication. Similarly there were no statistically significant associations between incidence of stricture, age at first stricture and number of dilatations, and administration of antacid medication either as prophylaxis nor when given as treatment for symptoms or signs of GOR.

Conclusions: These data do not support the hypothesis that prophylactic antacid medication reduces the incidence or severity of anastomotic stricture following repair of OA. Treatment with antacids may be best reserved for those with symptoms or signs of GOR. Further prospective investigation of the role of antacid prophylaxis on stricture formation following OA repair is warranted.

More information

Identifiers

ORCID for Nigel Hall: orcid.org/0000-0001-8570-9374

Catalogue record

Export record

Altmetrics