Gastroesophageal Reflux Disease After Esophageal Atresia with Tracheoesophageal Fistula Repair

Pathophysiology and Complications

The International Network on Oesophageal Atresia identifies GERD, peptic esophagitis, gastric metaplasia, Barrett esophagus, anastomotic strictures, feeding disorders, dysphagia, and esophageal dysmotility as the most frequent gastrointestinal long-term complications in patients with esophageal atresia with tracheoesophageal fistula after surgical repair, according to the American Gastroenterological Association 1, 2, 3, 4
Esophageal dysmotility at the anastomotic site is a common issue after surgical repair, leading to GERD, as reported by the American Gastroenterological Association 1, 2
Potential esophageal shortening from the repair can contribute to the development of GERD, as noted by the American Gastroenterological Association 5

24-hour multichannel intraluminal impedance-pH (MII-pH) monitoring is the best available diagnostic tool for GERD in patients with esophageal atresia with tracheoesophageal fistula, according to the American Gastroenterological Association 6, 5
Endoscopy with biopsy should always be performed to rule out GERD complications, including esophagitis, strictures, and Barrett esophagus, as recommended by the American Gastroenterological Association 6, 5
Barium swallow should be conducted to rule out anatomical gastroesophageal alterations, as suggested by the American Gastroenterological Association 6, 5

Medical management with acid suppression is first-line therapy for GERD in patients with esophageal atresia with tracheoesophageal fistula, according to the American Gastroenterological Association 6, 5
Laparoscopic fundoplication is the recommended surgical approach when medical management fails, as reported by the Society of American Gastrointestinal and Endoscopic Surgeons 6, 5
High-dose PPI therapy should be optimized before considering surgical intervention, as recommended by the American College of Gastroenterology 8

Do not rely on symptoms alone to assess GERD severity - objective testing with MII-pH monitoring and endoscopy is mandatory, as emphasized by the American Gastroenterological Association 6, 5
Do not delay surveillance endoscopy, as consequences of untreated GERD include Barrett esophagus and potential malignancy in adulthood, as warned by the American Gastroenterological Association 1, 2