Tracheoesophageal fistula (TEF) is a birth defect where the esophagus is connected to the windpipe (trachea). This abnormality causes problems with swallowing. The esophagus is the muscular tube that carries food and drink from the mouth to the stomach. The trachea is a pipe that carries air from the nose and mouth to the lungs. In the anatomy of a healthy child these two tubes are not connected.
A tracheoesophageal fistula occurs during fetal development, when the esophagus connects to the trachea instead of the stomach. This allows stomach acid and other liquid to enter the lungs. When this happens, aspiration, pneumonia and other respiratory conditions can develop.
Babies born with this condition may not present with any immediate problems, but once they start to swallow their own saliva, it becomes obvious that something is not functioning properly.
The most apparent symptom of tracheoesophageal fistula is trouble swallowing. Other symptoms include:
There are different kinds of tracheoesophageal fistulas depending on where the abnormal connection between the esophagus and trachea occurs (top, bottom, middle or at both ends). The rarest form (called an H-type because the esophagus and trachea form an H shape) involves a side connection between the two pipes. An H-type fistula allows food to travel to the stomach but causes a delayed hiccup, because some fluid gets into the windpipe or lungs.
In about one half of babies with tracheoesophageal fistulas, another birth defect is also present. They include:
Children with tracheoesophageal fistulas may experience gastroesophageal reflux disease (GERD) and a narrowing (stricture) of the esophagus.
Pediatricians and pediatric surgeons at Riley at IU Health perform the following exams and tests to diagnose a tracheoesophageal fistula:
Surgery is the primary treatment for a tracheoesophageal fistula. Surgical treatment of tracheoesophageal fistulas can successfully separate the esophagus and trachea and properly align them with the stomach and lungs. Doctors at Riley at IU Health try to perform surgery as soon as possible.
Treatment options for tracheoesophageal fistula include:
Visit the link below to find support groups and services and learn more about tracheoesophageal fistulas.
Riley at IU Health offers a broad range of supportive services to make life better for families who choose us for their children's care.
This website from the American Pediatric Surgical Association provides parent-friendly information about tracheoesophageal fistulas, including information about surgical treatment.
The pediatric surgeons at Riley at IU Health participate in the Midwest Area Research Consortium for Health to study the best treatments and care delivery protocols for tracheoesophageal fistulas.
Specific areas of study include:
The consortium includes doctors from other regional hospitals who share outcomes from all cases of tracheoesophageal fistulas. The condition occurs about 20 times a year in Indiana.
In addition to our primary hospital location at the Academic Health Center in Indianapolis, IN, we have convenient locations to better serve our communities throughout the state.
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