Perioperative and long-term management of esophageal atresia | Overview
Yasuda JL, Staffa SJ, Nurko S, Kane M, Wall S, Mougey EB, Franciosi JP, Manfredi MA, Rosen R. Pharmacogenomics fail to explain proton pump inhibitor refractory esophagitis in pediatric esophageal atresia. Neurogastroenterol Motil. 2022 Jan;34(1):e14217. doi: 10.1111/nmo.14217. Epub 2021 Aug 1. PMID: 34337835.
Some children with esophageal atresia experience esophageal inflammation (esophagitis) despite taking acid suppressive medications. A fraction of the general population is genetically predisposed to rapidly metabolize and excrete proton pump inhibitors, which are the most commonly used type of acid suppressive medication; individuals who have this genetic predisposition may experience esophagitis that fails to respond to proton pump inhibitors. In this study, we showed that this genetic predisposition does not explain refractory esophagitis in esophageal atresia. We believe refractory esophagitis in esophageal atresia is instead more likely related to esophageal dysmotility and difficulty clearing reflux from the esophagus.
Yasuda JL, Taslitsky GN, Staffa SJ, Ngo PD, Meisner J, Mohammed S, Hamilton T, Zendejas B, Manfredi MA. Predictors of enteral tube dependence in pediatric esophageal atresia. Dis Esophagus. 2023 Feb 24;36(3):doac060. doi: 10.1093/dote/doac060. PMID: 36065605.
This study explores the clinical factors associated with feeding difficulties and reliance on enteral tube feedings (such as G-tube or GJ-tube feeds) in children with esophageal atresia. We found that having an esophageal stricture is a risk factor for feeding difficulties, highlighting the importance of a proactive approach to monitoring for and treating strictures.
Yasuda JL, Clark SJ, Staffa SJ, Blansky B, Ngo PD, Hamilton TE, Smithers CJ, Jennings R, Manfredi MA. Esophagitis in Pediatric Esophageal Atresia: Acid May Not Always Be the Issue. J Pediatr Gastroenterol Nutr. 2019 Aug;69(2):163-170. doi: 10.1097/MPG.0000000000002336. PMID: 30921254.
Esophageal inflammation (esophagitis) is extremely common in esophageal atresia and is thought to contribute to certain long-term risks associated with esophageal atresia, such as long-term increased risk of Barrett’s esophagus (a precancerous condition of the esophagus). In this study we found high rates of esophagitis despite regular use of acid suppressive medications, highlighting the importance of using endoscopy to search for esophagitis in order to tailor appropriate treatment to effectively control esophagitis for each individual patient.