Esophageal Atresia

Esophageal Atresia

Esophageal atresia is a congenital disorder of the esophagus that usually requires surgical treatment. The success of the therapy is often good.

What is esophageal atresia?

Esophageal atresia is a malformation of the esophagus. Esophageal atresia is characterized, among other things, by a severely narrowed or completely missing connection between the esophagus and the stomach. For radius head fracture definition and meaning, please visit howsmb.com.

As a result, the food consumed by the person affected cannot reach the stomach naturally. Congenital esophageal atresia can take different forms depending on the patient; in the vast majority of those affected (in about 85% of cases), esophageal atresia is accompanied by a connection (fistula) between the esophagus and trachea that does not correspond to the healthy anatomy.

Such a case is referred to in medicine as esophageal atresia with tracheoesophageal fistula. This tracheo-oesophageal fistula can cause problems with saliva or gastric juice getting into the airways or with air from the airways causing the stomach to swell.

Various forms of esophageal atresia occur in about 1 in 3,000 newborns on average. Boys show the developmental disorder slightly more often than girls.

Causes

The causes of esophageal atresia are still largely unknown to medicine.

However, it is assumed that the development of esophageal atresia begins in the fetus during the first weeks of pregnancy. The developmental disorder means that the separation between the esophagus and trachea in the affected fetus is limited.

This assumption is supported, among other things, by the large number of patients who, in addition to esophageal atresia, also have a fistula between the esophagus and trachea.

Symptoms, Ailments & Signs

All forms of esophageal atresia cause severe discomfort to the affected newborn and lead to death if left untreated. Newborn infants suffering from esophageal atresia are initially noticed by increased salivation. The baby also suffers from extreme shortness of breath and a strong cough.

The esophagus and trachea are connected by fistula formation. As a result, food residues always get into the trachea when the children are fed. The skin and mucous membranes turn blue ( cyanosis ) because the body can no longer be supplied with enough oxygen. Artificial feeding via a gastric tube is not possible.

It fails because of a resistance because the connection between the esophagus and the stomach is either missing or only insufficiently developed. In certain forms of esophageal atresia, so-called aspiration pneumonia often occurs, which manifests itself in increased secretion and spasms of the bronchial muscles with increased shortness of breath and even cyanosis.

Since the condition of esophageal atresia is life-threatening for the infant, the strictures and fistulas must be surgically removed as a matter of urgency. The survival of the child can be secured up to 90 percent through the surgical treatment. However, the success of the treatment also depends on possible other organic malformations, which, in addition to the esophagus, can also affect the gastrointestinal tract, the heart, the kidneys, the spine or the extremities.

Diagnosis & History

In many cases, the suspicion of an existing esophageal atresia can already be made during prenatal diagnostics (examinations on the fetus in the womb).

Ultrasound recordings in particular are used for this purpose. In this context, an increased amount of amniotic fluid (also referred to in medicine as so-called polyhydramnios ) in the expectant mother can indicate esophageal atresia.

However, definitive diagnostic confirmation of esophageal atresia can usually only be made after examining the newborn using a nasogastric tube and/or x-rays. Symptoms that may indicate esophageal atresia in a newborn include increased amounts of foamy saliva and severe coughing during feeding attempts.

Successfully treated esophageal atresia in the newborn usually requires several years of follow-up treatment. Possible complications after treatment include, for example, relaxation of the trachea or renewed narrowing in the treated area of ​​the esophagus. Especially in infants with a birth weight of more than 1500 g and an intact heart, esophageal atresia can be treated successfully in most cases.

Complications

If the esophagus is so badly deformed that food can no longer enter the digestive tract naturally, or if the connection between the esophagus and the stomach is completely missing, this disorder can be fatal if left untreated. However, the malformation can usually be corrected surgically.

In the case of severe esophageal atresia, the intervention is already necessary in childhood. Complications from this operation are observed more often in children than in adults. On the one hand, a shrinkage of the suture is to be expected, which can result in a stricture and a resulting hindrance to eating.

If there is scarring on the esophagus as a result of the operation, this can have a similar effect. There is also a risk of suture insufficiency, which is particularly the case when a larger defect has to be corrected. In this case, there is also an increased risk of fistulas forming, which in the worst case can even affect the lungs.

In addition, another risk specific to children occurs frequently. After the surgical correction of esophageal atresia, follow-up interventions are often necessary because the children have swallowed foreign objects and these are blocking the esophagus more often than usual.

When should you go to the doctor?

Esophageal atresia is a congenital disorder of the esophagus. Therefore, the first disorders and abnormalities appear immediately after birth. If there are irregularities during food intake or breathing disorders, the newborn needs medical care as quickly as possible. If your skin turns blue, you look pale or your breathing is impaired, you need to take action as quickly as possible. A lack of strength or restrictions in the movements of the baby are to be understood as a warning signal. If shortness of breath occurs, first aid measures must be taken by those present, otherwise there is a risk of premature death.

In most cases, delivery takes place in the presence of obstetricians or medically trained personnel. Therefore, the first irregularities are already noticed by the nursing team and necessary steps are automatically initiated. If an abnormality is noticed when feeding the infant, if there are irregularities in the act of swallowing or increased salivation, there is a need for action. Since this disease can lead to premature death, professional action must be taken quickly and immediately. If coughing occurs or ingested food items are vomited up immediately, the infant needs medical help. Special features of the heart rhythm, optical abnormalities of the physique and malformations must be examined and treated in more detail.

Treatment & Therapy

Esophageal atresia usually requires surgical intervention as early as possible in the affected infant. In the run-up to a corresponding operation, the upper body of a sick child is usually elevated. A probe is then used to constantly aspirate saliva and other secretions that cannot be swallowed due to the presence of esophageal atresia.

Which surgical methods are used to treat esophageal atresia in individual cases depends primarily on the form and severity of the malformation. For example, if the connection between the upper and lower parts of the esophagus is only missing over a comparatively short distance, this defect can often be repaired in a single operation.

If, in the context of esophageal atresia, the parts of the esophagus need to be connected over longer distances, it is possible, for example, to initially lengthen the esophagus over a certain period of time or to replace missing parts with tissue from the intestine or stomach. Existing fistulas to the airways must be closed so that breathing is not endangered by penetrating foreign bodies.

Prevention

Since the exact causes of esophageal atresia are unknown, the developmental disorder can hardly be prevented. However, regular prenatal check-ups can help to detect signs of esophageal atresia at an early stage. In this way, necessary medical measures can be taken quickly after the birth of an affected child.

You can do that yourself

If esophageal atresia is present, a hospital or specialist clinic should be consulted as soon as possible. In acute cases, the emergency doctor must be alerted, as an emergency operation may have to be initiated immediately. After an operation, the sick child has to take it easy. Moderate exercise is possible in consultation with the pediatrician, where the state of health is decisive.

Parents should also follow the doctor’s instructions for wound care. If complications arise, it is best to inform the doctor immediately. Side effects and interactions must also be discussed with a specialist.

In addition, it is important to determine the cause of the esophageal atresia and, in cooperation with the doctor, to ensure that a medical emergency does not arise again. The syndrome is usually congenital, which is why the usual newborn screenings are sufficient as a diagnostic method. However, the parents of the affected child should watch out for any unusual symptoms and, if in doubt, inform the doctor.

In addition, it can be useful to deal with the stress associated with the condition as part of a therapy. This is particularly important if the disease is severe.

Esophageal Atresia