Gastric emptying in children with cerebral palsy and gastroesophageal reflux

CONTEXT AND OBJECTIVE: Association between neurological lesions and gastroesophageal reflux disease (GERD) in children is very common. When surgical treatment is indicated, the consensus favors the fundoplication technique recommended by Nissen, despite its high morbidity and relapse rates. Vertical gastric plication is a procedure that may have advantages over Nissen fundoplication, since it is less aggressive and more adequately meets anatomical principles. The authors proposed to compare the results from the Nissen and vertical gastric plication techniques. DESIGN AND SETTING: Randomized prospective study within the Postgraduate Surgery and Experimentation Program of Unifesp-EPM, at Hospital do Servidor Público Estadual (IAMSPE) and Hospital Municipal Infantil Menino Jesus. METHODS: Fourteen consecutive children with cerebral palsy attended between November 2003 and July 2004 were randomized into two groups for surgical treatment of GERD: NF, Nissen fundoplication (n = 7); and VGP, vertical gastric plication (n = 7). These were clinically assessed by scoring for signs and symptoms, evaluation of esophageal pH measurements, duration of the operation, intra and postoperative complications, mortality and length of hospital stay. RESULTS: The mean follow-up was 5.2 months; symptoms were reduced by 42.8% (NF) (p = 0.001) and 57.1% (VGP) (p = 0.006). The Boix-Ochoa score was favorable for both groups: NF (p < 0.001) and VGP (p < 0.042). The overall mortality was 14.28% in both groups and was due to causes unrelated to the surgical treatment. CONCLUSION: The two operative procedures were shown to be efficient and efficacious for the treatment of GERD in neuropathic patients, over the study period.

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FOOD INTAKE, NUTRITIONAL STATUS AND GASTROINTESTINAL SYMPTOMS IN CHILDREN WITH CEREBRAL PALSY

Arquivos de Gastroenterologia ◽

10.1590/s0004-2803.201800000-78 ◽

2018 ◽

Vol 55 (4) ◽

pp. 352-357 ◽

Cited By ~ 5

Author(s):

Deise Cristina Oliva CARAMICO-FAVERO ◽

Zelita Caldeira Ferreira GUEDES ◽

Mauro Batista de MORAIS

Keyword(s):

Cerebral Palsy ◽

Food Intake ◽

Gastroesophageal Reflux ◽

Nutritional Status ◽

Fluid Intake ◽

Gastrointestinal Symptoms ◽

Z Score ◽

Children With Cerebral Palsy ◽

Height For Age ◽

Weight For Age

ABSTRACT BACKGROUND: Cerebral palsy may be associated with comorbidities such as undernutrition, impaired growth and gastrointestinal symptoms. Children with cerebral palsy exhibit eating problems due to the effect on the anatomical and functional structures involved in the eating function resulting in malnutrition. OBJECTIVE: The aim of this study was to investigate the association between food intake, nutritional status and gastrointestinal symptoms in children with cerebral palsy. METHODS: Cross-sectional study that included 40 children with cerebral palsy (35 with spastic tetraparetic form and 5 with non-spastic choreoathetoid form of cerebral palsy, all requiring wheelchairs or bedridden) aged from 4 to 10 years. The dietary assessment with the parents was performed using the usual household food intake inquiry. Anthropometric data were collected. Gastrointestinal symptoms associated with deglutition disorders, gastroesophageal reflux and chronic constipation were also recorded. RESULTS: The median of height-for-age Z-score (-4.05) was lower (P<0.05) than the median of weight-for-age (-3.29) and weight-for-height (-0.94). There was no statistical difference between weight-for-age and weight-for-height Z-scores. Three patients with cerebral palsy (7.5%) exhibited mild anemia, with normal ferritin levels in two. Symptoms of dysphagia, gastroesophageal reflux, and constipation were found in 82.5% (n=33), 40.0% (n=16), and 60.0% (n=24) of the sample, respectively. The patients with symptoms of dysphagia exhibited lower daily energy (1280.2±454.8 Kcal vs 1890.3±847.1 Kcal, P=0.009), carbohydrate (median: 170.9 g vs 234.5 g, P=0.023) and fluid intake (483.1±294.9 mL vs 992.9±292.2 mL, P=0.001). The patients with symptoms of gastrointestinal reflux exhibited greater daily fluid intake (720.0±362.9 mL) than the patients without symptoms of gastroesophageal reflux (483.7±320.0 mL, P=0.042) and a greater height-for-age deficit (Z-score: -4.9±1.7 vs 3.7±1.5, P=0.033). The patients with symptoms of constipation exhibited lower daily dietary fiber (9.2±4.3 g vs 12.3±4.3 g, P=0.031) and fluid (456.5±283.1 mL vs 741.1±379.2 mL, P=0.013) intake. CONCLUSION: Children with cerebral palsy exhibited wide variability in food intake which may partially account for their severe impaired growth and malnutrition. Symptoms of dysphagia, gastroesophageal reflux, and constipation are associated with different food intake patterns. Therefore, nutritional intervention should be tailored considering the gastrointestinal symptoms and nutritional status.

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Morphofunctional features of organs in children with cerebral palsy

Experimental and Clinical Gastroenterology ◽

10.31146/1682-8658-ecg-173-1-56-65 ◽

2020 ◽

pp. 56-65

Author(s):

A. A. Kamalova ◽

R. F. Rakhmaev ◽

Yu. V. Malinovskaya

Keyword(s):

Quality Of Life ◽

Cerebral Palsy ◽

Gastroesophageal Reflux Disease ◽

Gastroesophageal Reflux ◽

Gastrointestinal Function ◽

Gastrointestinal Manifestations ◽

Children With Cerebral Palsy ◽

Rehabilitation Potential ◽

Chronic Course

Problems associated with impaired gastrointestinal function are common in children with cerebral palsy. Typical gastrointestinal manifestations of cerebral palsy include dysphagia, gastroesophageal reflux disease and constipation, which in chronic course lead to the development of nutritional status disorders, micronutrient insufficiency, osteopenia, reduced immunity and rehabilitation potential. Often it is the gastroenterological aspects of management of children with cerebral palsy that determine the quality of life of the child and his family.

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