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.
- 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.
- 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%).
- Thoracic (face and profile),
- Of the abdomen.
- Cardiac ultrasound scan .
- GERD Treatment:
- PPI ,
- Medicine for gastric motility,
- Treatment of complications :
- 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).
- A multidisciplinary follow up is necessary in particular with regard to the many complications of this malformation on the following levels:
- 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.
NHS page on OA
TOFS, Support group
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L'atrésie de l'oesophage (HAS)
La atresia del esófago (HAS)