Esophageal Atresia and Tracheoesophageal Fistula

Overview

What is esophageal atresia?

In babies who have esophageal atresia (say “ee-sof-ah-gee-all at-tree-see-ah”), the esophagus doesn’t connect to the stomach. It just ends in a pouch, so nothing the baby swallows gets into the stomach.

What is a tracheoesophageal fistula?

A fistula (say “fist-you-lah”) is a connection between 2 of the body’s tubes. A tracheoesophageal (say “tray-key-oh-ee-sof-ah-gee-all”) fistula is when the trachea (the breathing tube that connects the nose and mouth with the lungs) and the esophagus (the swallowing tube) are connected. These tubes aren’t normally connected. When they are connected, food or milk can get into your baby’s lungs when he or she swallows. This can cause breathing problems and even pneumonia (say “new-mone-yah”).

Are these problems common?

About 1 baby out of 4,000 babies has one or both of these problems. They usually occur together. But sometimes a baby has atresia with no fistula or fistula with no atresia.

Causes & Risk Factors

What causes esophageal atresia and tracheoesophageal fistula?

Doctors are not yet sure exactly what causes these problems. When your child’s esophagus and the trachea started to grow in the womb, they started from the same bit of tissue. Sometimes the tubes don’t develop correctly. It’s not thought that these problems are inherited.

Diagnosis & Tests

How does the doctor know this is what’s wrong with my baby?

Most babies who have one or both of these conditions have feeding problems right away. They may spit up a lot or have lots of bubbly mucus in their mouth. If your baby has a fistula, breathing may be hard. If your doctor thinks your baby has one of these conditions, an X-ray can help make the diagnosis.

Treatment

How is this problem fixed?

Your baby will need surgery to fix the problem. If your baby has atresia, first the swallowing tube must be connected to the stomach. Then, if a fistula is connecting the esophagus to the trachea, it must be closed. Your child’s doctor will decide when to do the surgery. If the baby isn’t premature and doesn’t have any other problems (such as pneumonia or other birth defects), the surgery can usually be done when the baby is just a few days old.

How long will my baby be sick?

In uncomplicated cases, your baby may be eating as soon as one week after surgery. Meanwhile, until your baby can swallow milk or formula, your baby will be fed through a vein (this is called an “IV”) or through a stomach tube. Your baby will stay in the hospital during this time. However, if your baby was premature or if the operation was complicated, the recovery time might be a little longer.

Complications

Does my baby have any other problems?

Some babies who have esophageal atresia also have heart problems, kidney problems, stomach and bowel problems or muscle and bone problems. A physical exam by your doctor, maybe with some other X-ray or ultrasound pictures, will usually show if your baby has other problems. If your baby has other problems, the surgery to fix the swallowing tube might have to wait until these problems can be fixed.

Will my baby have other problems in the future?

Babies born with esophageal atresia sometimes have long-term problems, the most common of which is gastroesophageal reflux disease, or GERD. GERD is similar to heartburn, and can usually be treated with medicine. Another problem is scar tissue. Sometimes scar tissue grows where the esophagus connects to the stomach. This scar tissue can make swallowing hard or painful because the food can’t easily get past the scar tissue. Sometimes another surgery is needed to open the scar tissue. Your child may need more X-rays or endoscopy later to check on the area where the surgery was performed. Endoscopy is a way of taking a picture of the inside of the body. A narrow tube holding a tiny camera is put into the esophagus. The picture helps your doctor see inside the esophagus and stomach.

Questions to Ask Your Doctor

  • Are there other options besides surgery?
  • How long will my baby be in the hospital, and how long will it take her to recover?
  • What health condition is my baby at risk of, and how can I help prevent them?
  • What caused this condition? Was it inherited?
  • Will my baby be in pain after surgery?
  • What medicine will help my baby recover? What are possible side effects?

Citations

  • Esophageal Atresia and Tracheoesophageal Fistula by DC Clark( 02/15/99, http://www.aafp.org/afp/990215ap/910.html)