Commonly Asked Questions about Esophageal Atresia and Tracheoesophageal Fistula
Kathryn Anderson, one of our medical advisors, is well known in the medical field for her interest and work with these anomalies. She is Chief of Surgery at Children's Hospital Los
Angeles. Q: When did the first treatments for esophageal atresia and tracheoesophageal fistula begin, and what long-term problems, if any, are associated with them? Q: Is there a shorter life expectancy or any greater risk for cancer associated with reflux and/or dilations of the esophagus? Q: Is there any nutritional long-term damage associated with a liquid formula diet? Q: We know that between the 23rd-28th
day of pregnancy the trachea and esophagus divide into two tubes. What can cause, if anyone knows a cause, something to go wrong with the division? Q.: If a child has tracheomalacia and the TEF "cough," as they get older, will it get louder, worse, or hopefully, go away? Q: If a child's esophagus has no motility at all, can anything be done to help it? As they get older, what problems could the child have with eating? Q: Why do some children have poor motility? Q: What can I do to make oral feedings possible in a child with no esophageal motility?
A: The first successful anastomosis was in 1941.
Long term problems are 1) Poor motility of the esophagus, 2) Potential for reflux and stricture, and/or 3) Aspiration (spillover into lungs). Some kids have no problems; others seem to have many problems. Unfortunately,
they are not predictable.
A: If reflux produces a change in the esophageal lining, then
"Barrett's esophagus," a pre-cancerous condition, could occur. Therefore, all children should have lifelong monitoring.
A: No, as
long as all the nutrients are given, including vitamins, trace elements, etc.
A: No one really knows, but the blood supply changes abruptly in
mid-esophagus. We know that in other areas of the intestine, cutting off the blood supply will result in atresia. Why this happens in an individual during pregnancy is not known. We know of no association with any pregnancy
events, drug taking, etc.
A: Usually this goes away at 18 month to two years, as the cartilage
of the trachea gets stronger. The trachea is strutted in the fetus by the upper pouch, which may get full as the fetus swallows. Once the esophageal pouch is separated during the operation for TEF/atresia, the trachea
begins to "flap in the breeze" as air goes in and out. This occurs sometimes without atresia and usually gets well. (Compare the ear cartilage of a tiny infant versus an older infant or child.) Occasionally, this
narrowing of the trachea with each breath becomes so severe the breath is cut off. Then we have to pull the trachea forward to hold it open. WE do this by sewing the aorta (the large blood vessel), to which the trachea is
naturally attached, to the back of the breastbone.
A: This is
unfortunately an unpredictable problem. Occasionally, kids cannot eat at all by mouth and wind up with the esophagus being replaced.
A: We don't know. Both upper
and lower pouches have poor motility, and putting them together does not provide motility where there was none.
A: Keep
trying. Offer food after a period of no gastrostomy feedings, when the child is hungry.
(Ed. Note: Poor motility is one of the biggest problems we have seen with children born with esophageal atresia or tracheoesophageal fistula. There are speech therapists who have been studying this problem, and those who specialize in working with children with swallowing difficulties. To find a speech-language pathologist in the United States who is experienced in evaluating and treating swallowing problems, you can call the American Speech-Language-Hearing Association Help line at (800) 638-8255 or (301) 897-8682.)
Q: If a child loves spicy foods and acidic foods, is it because they were born with these anomalies? Q: Are children with TEF more prone to respiratory problems and/or asthma more than children without TEF? Q: Do children with TEF sound more congested
in the winter, and if so, why? Q: How will this birth defect affect my child in adulthood? Q:
What are possible long-term problems of a colon interposition? Q: Will this ever end?
A: None whatsoever.
A: Yes, Asthma has now been divided into two
diagnoses: 1) Reactive airway disease, which is what TEF children usually have. This usually goes better and does not usually develop into 2: True asthma, which is lifelong.
A: We're all more prone to colds and respiratory symptoms in winter, and the TEF children are no exception.
A: It may not
at all. Some adults may have to eat slowly and chew their food well. The condition occasionally runs in families, but this is rare, so most children can expect their own children not to have this condition.
A: Esophageal substitutes (colon, gastric tube, etc.) work quite well as a rule, long-term. Occasionally ulcers can occur, and even more occasionally they
can bleed. But most kids get along well. Two of "my kids" now have children of their own.
A: Most of the time things get better. Children are so adaptable...they take things in their
stride better than adults do!
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