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Eur J Pediatr Surg
DOI: 10.1055/a-2767-4535
Original Article

Gastro-Esophageal Reflux in Esophageal Atresia Patients Remains a Challenge: Results from a Systematic Review and Meta-Analysis

Authors

  • Alexander Sterlin 

    1   Department of Pediatric Surgery, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
    2   Department of Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom

  • Hanna Garnier

    3   Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
    4   Department of Pediatric Surgery, Public Assistance Hospitals, Paris University Paris Saclay, Le Kremlin-Bicêtre, Île-de-France, France

  • Gabriela Vallejo 

    5   Department of Pediatrics, ISMETT, Palermo, Sicily, Italy
    6   Department of Pediatric Surgery, University of Messina Faculty of Medicine and Surgery, Messina, Sicily, Italy

  • Joana M. Monteiro

    7   Department of Plastic Surgery, Great Ormond Street Hospital for Children, London, United Kingdom

  • Julio C. Moreno-Alfonso 

    8   Department of Pediatric Surgery, Navarre Hospital Complex, Pamplona, Navarre, Spain

  • Hilmican Ulman 

    9   Department of Pediatric Surgery, Ege University Faculty of Medicine, İzmir, Turkey

  • Giovanna Riccipetitoni 

    10   Department of Diagnostic and Pediatric Science, University of Pavia Faculty of Medicine and Surgery, Pavia, Lombardia, Italy

  • Marta Gazzaneo 

    2   Department of Neonatal and Paediatric Surgery, Great Ormond Street Hospital for Children, London, United Kingdom
    11   Department of Pediatric Surgery, University of Brescia, Brescia, Lombardy, Italy
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Graphical Abstract

Abstract

Objective

Although international guidelines address the management of esophageal atresia (EA), the optimal approach to gastroesophageal reflux disease (GERD) in this population remains controversial. This systematic review and meta-analysis aims to clarify the current management of GERD in children after EA repair, reporting the prevalence of GERD, indications, and effectiveness of medical and surgical therapies.

Methods

A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. A literature search was performed in MEDLINE, Cochrane Database, and Web of Science. Studies involving patients under 18 years old with GERD following EA repair were included. Data were extracted on incidence, diagnostic approach, medical and surgical management, and outcomes.

Results

Out of 1,612 articles, 49 (5,613 patients) were included. Reporting diagnostic modality, pH-impedance was most frequently used. The pooled GERD incidence was 36.7% overall and 58.1% in type A/B EA. Postoperative anti-reflux medication was reported in 88% of patients; 53.8% of children receiving medical therapy subsequently required further procedures (anti-reflux surgery [ARS], feeding stoma, or total esophago-gastric dissociation). ARS was more common in type A/B than in type C/D cohorts. Resolution of symptoms after ARS was reported in 74.5% of patients. Complications following ARS occurred in 28.3%, with a 14.9% rate of redo fundoplication, and the highest incidence occurred in infants < 6 months. The data on timing and type of ARS were heterogeneous.

Conclusion

GERD affected over one-third of EA patients, with higher prevalence in types A and B. Although proton pump inhibitor therapy is common, a large proportion required ARS, with higher complication rates in smaller children. These findings highlight the need for standardized diagnostic criteria and multicenter prospective registries with long-term follow-up to clarify optimal timing and technique.

Keywords

EA - gastroesophageal reflux - pediatric surgery - systematic review - ARS

Supplementary Material



Publication History

Received: 13 April 2025

Accepted: 08 December 2025

Article published online:
24 December 2025

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