Oesophageal Atresia

August 2017
Here are some recommendations concerning the diagnosis, care and management of children affected by the congenital malformation of oesophageal atresia (OA).

The OA concerns 150 to 200 newborns each year.


Definition

  • The OA is defined as being a congenital malformation of the oesophagus which continues the oesophageal final pouch ending, an upper and a lower, which may or may not communicate (one or both) with the tracheobronchial tree”, i.e. the oesophagus is in fact interrupted and prevents from normal feeding.
  • The majority of cases of OA present a fistula between the lower part of the oesophagus and the trachea.
  • There are several oesophageal atresia :
    • OA with fistula ;
    • OA without fistula ;
    • OA with double fistula.

Diagnosis

Clinical examinations

  • The diagnosis can be
    • Antenatal (presence of hydramnios),
    • At birth
      • Hypersalivation or cough at inhalation
      • While feeding (regurgitation of milk, wrong track…)
      • By a probe (pouch ending)
    • In half the cases, one finds associated malformations of the following type::
      • Cardiovascular (29%),
      • Digestive (13%),
      • Anorectal (14%),
      • Genitourinary (14%),
      • Vertebral (10%),
      • Pulmonary (6%),
      • Chromosomal (4%).

Paraclinical examinations

  • X-ray
    • Thoracic (face and profile),
    • Of the abdomen.
    • Cardiac ultrasound scan .

Treatments

Medication

  • GERD Treatment:
    • PPI ,
    • Anti-H2,
    • Medicine for gastric motility,
    • Antacid.
  • Treatment of complications :
    • ENT,
    • Respiratory.

Surgery

  • Closing of the fistula.
  • Oesophageal lengthening or replacement (stomach, small intestine…).
  • Treatment of complications.
  • Treatment :
    • Of GERD (Gastroesophageal Reflux),
    • Of tracheomalacia ,
    • Of pulmonary after-effects,
    • Of malformations associated with OA.
  • Gastrostomy, Jejunostomy of feeding.
  • Oesogastric disconnection (if impossible enteral nutrition because of a severe GERD).

Follow up

  • A multidisciplinary follow up is necessary in particular with regard to the many complications of this malformation on the following levels:
    • Digestive
      • GERD
      • Orality disorder
    • Pulmonary
      • Tracheomalacia
      • Repeating bronchitis
      • Dyskinesia bronchitis.
    • Complications due to the first surgical operation can require new surgical treatments.
    • The consultation of several specialists is necessary:
      • At 3 months: 1st consultation;
      • At 6 months and 12 months: consultations;
      • At 18 months: 2nd multidisciplinary consultation (stop GERD treatment);
      • At 24 months: consultations of specialists;
      • At 3 years: consultations of specialists;
      • At 6 years: 3rd multidisciplinary consultation (assessment respiratory status);
      • Up to 15 years: annual or bi-annual consultation of specialists;


It is important to supervise the evolution of the mucus of the oesophagus and the respiratory conditions; the following is recommended:
  • pH Monitoring without treatment: at the age of 2 to 3 years;
  • Respiratory functional explorations: at the age of 7 to 9 years;
  • High digestive endoscopy and biopsies at the age of 16-17 years.

Sources

NHS page on OA
TOFS, Support group

Photographic copyright: Moke | Dreamstime.com

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Latest update on November 11, 2009 at 11:12 AM by owliance.en_ctrl_002.
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