Reflux in Infants With Tracheoesophageal Fistula Repair

Often associated with other congenital abnormalities, tracheoesophageal fistula (TEF) is a serious condition that is typically noted shortly after birth and sometimes before with ultrasound and other diagnostic studies performed during pregnancy. TEF requires surgical correction. Frequently undertaken at just a few days of life, the surgery holds certain risks for the infant. Depending upon the seriousness of other possible birth defects, the prognosis for many needing TEF repair is good.

TEF

A tracheoesophageal fistula involves the trachea (tube that runs through the chest cavity and carries air to the lungs) and esophagus (tube that runs alongside the trachea and carries food to the stomach). Initially, the trachea and esophagus in a developing fetus are one long, hollow tube. Four to eight weeks after conception, a wall forms and creates two tubes. If the wall is not continuous, a fistula or connection between the two occurs. In that case, foods/fluids can move from the esophagus through the fistula into the trachea and lungs. The abnormal esophagus causes problems with swallowing and digesting food.

TEF Repair

A baby with TEF will need surgery to close the connection between the esophagus and trachea. Surgeons will typically make an incision into the right chest and resect the fistula, closing the defect with sutures. In some cases, a baby may have other health complications that require postponing the surgery for a time. If so, the infant will likely need a gastrostomy tube (feeding tube in the stomach) and a stay in the intensive care unit until surgery.

Reflux

Reflux occurs when acids and stomach content flow back from the stomach to the esophagus. When they come in contact with the inner lining of the esophagus, these caustic gastric fluids can cause pain and burning, also known as heartburn, or vomiting. It is a common problem in all infants, and Lucile Packard Children's Hospital at Stanford (LPCH) reports that approximately one-half of children who have had TEF repair will develop chronic reflux after the surgery.

Reflux Treatment

Medications that help reduce acid in the stomach, such as Tagamet and Zantac, may be used in doses appropriate for infants, as determined by the baby's physician. Doctors may also choose to use a medication such as Reglan, which helps the stomach empty faster, possibly reducing the risk of reflux. Sometimes tube feeding is required due to other congenital conditions. Trials of different formulas (such as soy) and changes in feeding regimens (smaller more frequent meals) are often successful in helping prevent reflux. In the most severe cases, a procedure known as fundoplication (when the upper stomach is "wrapped" around the esophagus) may be necessary to decrease reflux.

Those at Risk

LPCH estimates one in 4,000 have TEF. TEF is not considered an inherited disorder, but often occurs in infants with other congenital defects such as Down syndrome, diaphragmatic hernia and other digestive conditions, heart defects, kidney defects, musculoskeletal issues or a syndrome known as VACTERL (vertebral, anal, cardiac, TEF, renal and limb abnormalities).