Abstract

Esophageal atresia should be diagnosed by lack of success in passing a tube from mouth to stomach soon after birth. Chest and abdominal radiographs are necessary to determine the presence of pneumonia, tracheoesophageal fistula, and coexisting anomalies which affect the treatment and prognosis. A review of 228 children with esophageal atresia, or tracheoesophageal fistula, or both seen at The Hospital for Sick Children in a 10 year period showed 83 per cent of them to have atresia with distal fistula, 10 per cent to have atresia without fistula, six per cent to have H fistulas, and less than one per cent to have proximal fistulas. Coexisting anomalies and prematurity were important in determining the prognosis. A remarkable 26 per cent of patients with atresia alone also had Down's syndrome. Patients with repaired esophageal atresia often have a characteristic cough and recurrent respiratory infections. They have a narrow and collapsible trachea which may be lined with squamous epithelium. There is a typical esophageal motility pattern in patients with repaired atresia. Peristalsis starts normally in the proximal esophagus but stops a short distance above the site of anastomosis. Contraction of the distal esophagus may be peristaltic or static and may or may not be accompanied by relaxation of the inferior esophageal sphincter. Intraluminal pressure studies may be helpful in clarifying distorted motility.

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