Oesophageal Atresia and Tracheo-Oesophageal Fistula

Oesophageal atresia (OA) is a congenital medical condition where the oesophagus does not develop properly, resulting in a disruption or blockage of the oesophagus. This can lead to difficulties with feeding and breathing.

Types of Oesophageal Atresia

• Oesophageal atresia without tracheo-oesophageal fistula (OA): The oesophagus is interrupted, but there is no abnormal connection between the oesophagus and the trachea.
• Oesophageal atresia with proximal tracheo-oesophageal fistula: The upper part of the oesophagus connects to the trachea.
• Oesophageal atresia with distal tracheo-oesophageal fistula: The lower part of the oesophagus connects to the trachea.
• Oesophageal atresia with both proximal and distal tracheo-oesophageal fistulas: Both the upper and lower parts of the oesophagus connect to the trachea.

Causes and Risk Factors

The exact cause of oesophageal atresia is unknown, but it is believed to occur during fetal development. Certain risk factors may increase the likelihood of OA, including:

• Family history of OA or other congenital anomalies
• Prenatal exposure to certain substances, such as tobacco smoke
• Certain genetic syndromes, such as VACTERL association

Symptoms

Infants with oesophageal atresia may exhibit the following symptoms:

• Drooling or excessive saliva production
• Coughing or choking during feeding
• Difficulty swallowing or refusal to feed
• Regurgitation of food or formula
• Respiratory distress, such as rapid breathing or grunting

Diagnosis

Oesophageal atresia is typically diagnosed shortly after birth, using a combination of the following methods:

• Chest X-ray to visualize the oesophagus and trachea
• Upper gastrointestinal series (UGI) to evaluate the oesophagus and stomach
• Endoscopy to directly visualize the oesophagus and trachea

Treatment

Treatment for oesophageal atresia typically involves surgical repair, which may include:

• Oesophageal anastomosis: The surgeon connects the two ends of the oesophagus to restore continuity.
• Tracheo-oesophageal fistula repair: The surgeon closes the abnormal connection between the oesophagus and trachea.
• Gastrostomy tube placement: A feeding tube is inserted into the stomach to provide nutrition until the oesophagus heals.

Complications and Prognosis

Infants with oesophageal atresia are at risk for various complications, including:

• Respiratory problems, such as pneumonia or chronic lung disease
• Nutritional deficiencies or growth delays
• Oesophageal stricture or narrowing
• Gastroesophageal reflux disease (GERD)

The prognosis for infants with oesophageal atresia is generally good, with most children experiencing significant improvement in symptoms and quality of life after surgical repair. However, some may require ongoing medical care and monitoring to manage potential complications.