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Gastroenterology (Expert Forum)
Repair of TE Fistula
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Repair of TE Fistula
by lhelms, Jul 18, 2004 12:00AM
My infant son was diagnosed with TE fistual and Esophageal Atresia at birth and underwent surgical repair on DOL #3. The gap was very small and there was very little stretching required for the repair. He weighed 5 lb 3 oz at birth and is now at three months and 12 pounds, so he is having no problems with weight gain.
He WAS spitting up sometimes - probably not more than a normal infant, but we went to see a GI specialist to be sure. A barium swallow showed that he had less than 10% stricture at the surgery site, but did have some reflux. He was put on .7 mls of Zantac three times daily. He still spits up occasionally (sometimes hours after his last meal) and even throws up once in a while. He is a voracous eater and has never refused to eat. He has a frequent croupy cough which we were told to expect, but which still concerns me slightly.
I'm wondering if this dose of Zantac is too high and if there is anything else we can be doing instead. I'm not even 100% sure that there is a problem to treat, and I worry about possible side effects of long term medicine use.
I am also curious about the long term prognosis for people with this condition. I have heard about frequent dialations, lifetime reflux problems, and worse. Are these likely, or are we just being told the worst case possibilities?
Thank you for your time - please let me know if there is other information that maybe useful to you (images of the barium swallow films, etc).
He WAS spitting up sometimes - probably not more than a normal infant, but we went to see a GI specialist to be sure. A barium swallow showed that he had less than 10% stricture at the surgery site, but did have some reflux. He was put on .7 mls of Zantac three times daily. He still spits up occasionally (sometimes hours after his last meal) and even throws up once in a while. He is a voracous eater and has never refused to eat. He has a frequent croupy cough which we were told to expect, but which still concerns me slightly.
I'm wondering if this dose of Zantac is too high and if there is anything else we can be doing instead. I'm not even 100% sure that there is a problem to treat, and I worry about possible side effects of long term medicine use.
I am also curious about the long term prognosis for people with this condition. I have heard about frequent dialations, lifetime reflux problems, and worse. Are these likely, or are we just being told the worst case possibilities?
Thank you for your time - please let me know if there is other information that maybe useful to you (images of the barium swallow films, etc).
Doctor's Answer
by Kevin Pho, MD, Jul 21, 2004 12:00AM
, Jul 21, 2004 12:00AM
Most who undergo surgery to correct these abnormalities have some degree of esophageal dysmotility. The extent of the repair dictates the severity of subsequent complications. Strictures at the site of the anastomosis are common and may subsequently require dilatation. Serial esophagraphy should be performed at two months, six months and one year of age, or whenever swallowing difficulties occur. Recurrence of the tracheoesophageal fistula has been reported; recurrence requires repeat surgical correction.
Approximately one half of patients with surgically corrected esophageal atresia develop gastroesophageal reflux disease (GERD). Of those who develop GERD, approximately one half respond to routine medical therapy with prokinetic agents, histamine H2 receptor blockers, or both, and one half require surgical intervention for correction. Patients with longstanding GERD may develop esophageal mucosal changes such as esophagitis and gastric metaplasia (Barrett's esophagus)
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Approximately one half of patients with surgically corrected esophageal atresia develop gastroesophageal reflux disease (GERD). Of those who develop GERD, approximately one half respond to routine medical therapy with prokinetic agents, histamine H2 receptor blockers, or both, and one half require surgical intervention for correction. Patients with longstanding GERD may develop esophageal mucosal changes such as esophagitis and gastric metaplasia (Barrett's esophagus)
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
Expert Activity
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Clark, D. Esophageal Atresia and Tracheoesophageal Fistula. Am Fam Physician. 1999 Feb 15;59(4):910-6, 919-20.
"I am also curious about the long term prognosis for people with this condition. I have heard about frequent dialations, lifetime reflux problems, and worse. Are these likely, or are we just being told the worst case possibilities?"
I was born in an air force hospital in Warrenton, England. I had TE Fistula repair when I was 13 hours old at Alder Hey Children's Hospital in Liverpool. I was given a 50% chance of survival. I had my esphagus dialated every 6 months until I was 5 years old. I have not had dilations since. I did choke growing up but nothing that my parents couldn't handle. I do suffer from heartburn and acid reflux but not enough to have to be on medication.
I am getting ready to celebrate my 49th birthday August 30th.
I do hope this helps you!