Tracheoesophageal Fistula

Overview of Tracheoesophageal Fistula

Tracheoesophageal fistula is a rare disease in which the trachea and esophagus of the baby are connected by birth. Surgery is said to be the only known treatment of TEF.

Tracheoesophageal fistula (TEF)is a disease in which the esophagus and the trachea are connected. The esophagus is a tube that is present in the body to deliver food to the stomach. The trachea, also known as the windpipe, is responsible for the passage of air into your lungs. The connection between these two tubes leads to the passage of swallowed food to the lungs. If the food directly enters the stomach this can lead to the build-up of stomach acid.

Most of the time TEF occurs with a related condition that is esophageal atresia (EA).  

Occurrence of  Tracheoesophageal Fistula

TEF does not occur because of inheritance. But the reason for TEF is mostly due to a birth defect. Children who have the following birth defects are more prone to TEF:

  • Trisomy 13, 18, 21
  • Digestive tract problems 
  • Cardiac problems
  • Kidney and urinary tract defects 
  • Skeletal or muscular issues 
  • VACTERL syndrome ( Vertebral, Anal, Cardia, TE fistula, Renal, and Limb abnormalities)

Signs and Symptoms of Tracheoesophageal Fistula

The symptoms of this disease are noticeable in the child soon after birth. Some of the most common symptoms of TEF are:

  • Formation of white or frothy bubbles in the mouth
  • Frequent coughing while feeding
  • Vomiting
  • Blue skin color is especially apparent when the baby is feeding
  • Respiratory issues (difficulty in breathing)
  • Round and full abdomen

Types of Tracheoesophageal Fistula

Tracheoesophageal fistula is a disease that is closely related to esophageal atresia. Based upon this connection of esophagus with trachea, TEF can be classified as follows:

Type A

In this condition the upper and the lower parts of the esophagus fail to connect. Trachea is not connected to the esophagus.

Type B

It is a rare condition. In this, the upper part of the esophagus is connected to the trachea, and the lower part of the esophagus is closed.

Type C

This type is reported to be the most common one. In this condition, the upper esophagus is closed and the lower part is attached to the trachea.

Type D


This is a severe type of TEF.  The upper and lower parts of the esophagus are not connected to each other but are separately connected to the trachea.


Causes of Tracheoesophageal Fistula

During the growth phase of the fetus, both the trachea and esophagus share one common origin. After 4 to 8 weeks of fetal development, thin walls start to form separating the esophagus and trachea into two separate tubes. The absence of this wall leads to the condition of tracheoesophageal fistula. 

Sometimes TEF can return even after primary treatment. An infection during surgery can cause this condition. If a TEF recurs, pressure on the esophagus doubles causing the fluids to pass through the airway. This leads to the swallowing of airways and the TEF becomes permanent. 


Risk Factors of Tracheoesophageal Fistula

Some children that are born with this disease may suffer from the side effects for a long time. Even after treatment, the child may have trouble swallowing. Scarring is another problem that a child might have to face after the surgery. This is because some wounds take a long time to heal and can even leave a scar.

Another condition that a child has to face is GERD. GERD is a gastrointestinal reflux disease. In this condition, the acid that is produced in the stomach starts to move up and gets accumulated in the esophagus. This condition causes burning sensations in children. It is possible to treat GERD with home remedies, medications, and minimally invasive surgical procedures.



Currently, there is no known preventive measure for this disease. But you have to be mindful of your health. Make sure to consult with your doctor during the pregnancy period. Furthermore, sit in comfortable positions and follow the guidelines of your doctor.




One of the primary diagnoses for TEF is a physical examination. The doctor may also ask questions about the medical history of the baby. X-ray is another means to check the chest and abdomen of the affected baby. 

In some cases, a small thin tube is also placed into the mouth, it is then guided towards the esophagus. This is called endoscopy.

Treatment of Tracheoesophageal Fistula | When to Consult a Doctor

Surgery is the most common treatment option for a baby who is suffering from TEF. But the type of surgery majorly depends upon the following factors:

  • Abnormality and its types 
  • Baby’s medical health and condition
  • The doctor’s opinion
  • Parents’ opinion 

After the completion of the surgery, the TEF is fixed. The connection between the trachea and the esophagus is closed in the surgery. The success rate of the surgery depends closely on the connection between the esophagus and the trachea. Most of the time, more than one surgery is required in the treatment of TEF. The primary health care physician or the doctor will decide the type of surgery. 

Make sure to properly discuss your child’s case with the Thoracic Surgeon from the treatment to follow-up.