*2.12.2.1 Gastro-oesophageal reflux*

Gastro-oesophageal reflux is a common complication after repair of OA [65]. It is probably related to shortening of the intra-abdominal portion of the oesophagus because of anastomotic tension and/or oesophageal motor dysfunction. The motor dysfunction may be intrinsic to the congenital anomaly or acquired from operative manipulation. Clinically, gastro-oesophageal reflux is suspected in patients with symptoms of vomiting, dysphagia and recurrent anastomotic stenosis. Episodes of foreign body or food bolus impaction may occur. Respiratory symptoms such as stridor, cyanotic spells, recurrent pneumonia and reactive airway disease are also suggestive of gastro-oesophageal reflux.

Upper gastrointestinal contrast study and 24-h pH probe data are diagnostic tools for gastro-oesophageal reflux. Multichannel oesophageal impedance combined with pH monitoring may emerge as a superior test. Abnormal oesophageal peristalsis and decreased lower oesophageal sphincter pressures after OA repair have been documented on oesophageal manometry. Medical management typically consists of thickening of feedings, positioning of the infant in a prone or upright posture, administration of acid reduction agents such as histamine-2 blockers, proton pump inhibitors and prokinetic agents. Antireflux operations are offered for patients with failed medical management, failure to thrive, chronic pulmonary infection, refractory anastomotic stricture or the development of a distal oesophageal stricture.
