scholarly journals Vertical gastric plication versus Nissen fundoplication in the treatment of gastroesophageal reflux in children with cerebral palsy

2007 ◽  
Vol 125 (1) ◽  
pp. 15-21 ◽  
Author(s):  
Antonio Paulo Durante ◽  
Sergio Tomaz Schettini ◽  
Djalma José Fagundes
Keyword(s):  
Cerebral Palsy ◽  
Surgical Treatment ◽  
Gastroesophageal Reflux ◽  
Nissen Fundoplication ◽  
Length Of Hospital Stay ◽  
Signs And Symptoms ◽  
High Morbidity ◽  
Gastric Plication ◽  
Esophageal Ph ◽  
Children With Cerebral Palsy

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.

scholarly journals Enfermedad por reflujo gastroesofágico y enfermedades neurológicas en pediatría: complicaciones funcionales y motoras post funduplicatura de Nissen

2020 ◽  
Vol 50 (4) ◽  
Author(s):  
María Alejandra Mortarini ◽  
Daniela Neder ◽  
Ana Rocca
Keyword(s):  
Cerebral Palsy ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Reflux Disease ◽  
Nissen Fundoplication ◽  
Neurological Impairment ◽  
Cross Sectional Study ◽  
Laparoscopic Technique ◽  
Surgical Time ◽  
Cross Sectional

Motility disorders are frequent in children with cerebral palsy. The prevalence of gastroesophageal reflux disease varies from the 15% to 75% in patients with cerebral palsy. Nissen fundoplication is the most used antireflux technique not without complications in this population. Our objective was to determine the frequency and the characteristics of the long-term functional and motility complications in patients with Nissen fundoplication and cerebral palsy. A descriptive cross-sectional study was performed. Data collection was acquired retrospectively with neurologic compromise between 2012 and 2017 in patients between 0 to 18 years old, with neurological impairment and Nissen fundoplication. 35 patients were included. Median age was 55 months (2-190). Gastroesophageal reflux disease was diagnosed in the 48%, in the 52% of this the diagnosis was clinical. It was performed by laparoscopic technique in the 91.4% of the cases gastrostomy was done in the same surgical time in 86% of the patients because of neurological impairment and risk of aspiration. In 25.7% (n = 9) there were functional and motor complications, Dumping syndrome (5.5%) accommodation disorders (11.4%) and recurrence of reflux (11.4%). Redo Nissen was required in the 8.5% of the patients (n = 3). In 75% of the patients with complications, gastrostomy was performed in the same surgical time. It could not be demonstrated that gastrostomy at the time of antireflux surgery was associated with greater frequency of complications.

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

2018 ◽  
Vol 55 (4) ◽  
pp. 352-357 ◽  
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.

scholarly journals Morphofunctional features of organs in children with cerebral palsy

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.

scholarly journals Surgical treatment of the non-complicated gastroesophageal reflux: fundoplication without division of the short gastric vessels

2002 ◽  
Vol 39 (2) ◽  
pp. 93-97 ◽  
Author(s):  
Valter Nilton FELIX ◽  
Ioshiaki YOGI ◽  
Marcos PERINI ◽  
Rodrigo ECHEVERRIA ◽  
Cristiano BERNARDI
Keyword(s):  
Surgical Treatment ◽  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Lower Esophageal Sphincter ◽  
Reflux Disease ◽  
Nissen Fundoplication ◽  
Erosive Esophagitis ◽  
Sphincter Pressure ◽  
Esophageal Sphincter ◽  
Short Gastric Vessels

Background - There is today a significant greater number of laparoscopic antireflux procedures for the surgical treatment of gastroesophageal reflux disease and there are yet controversies about the necessity of division of the short gastric vessels and full mobilization of the gastric fundus to perform an adequate fundoplication. Aim - To verify the results of the surgical treatment of non-complicated gastroesophageal reflux disease performing Rossetti modification of the Nissen fundoplication. Patients and Methods - Fourteen patients were operated consecutively and prospectively (mean age 44.07 years); all had erosive esophagitis without Barrett's endoscopic signals (grade 3, Savary-Miller) and they were submitted to the Rossetti modification of the Nissen fundoplication. Endoscopy, esophageal manometry and pHmetry were performed before the procedure and around 18 months postoperatively. Results - There was no morbidity, transient dysphagia average was 18.42 days; there was no register of dehiscence or displacement of the fundoplication and only one patient revealed a light esophagitis at postoperative endoscopy; the others presented a normal endoscopic view of the distal esophagus. All noticed a marked improvement of preoperative symptoms. Lower esophageal sphincter pressure changed from 5.82 mm Hg (preoperative mean) to 12 mm Hg (postoperative mean); lower esophageal sphincter relaxing pressure, from 0.38 mm Hg to 5.24 mm Hg and DeMeester score, from 16.75 to 0.8. Conclusion - Rossetti procedure (fundoplication without division of the short gastric vessels) is an effective surgical method to treat gastroesophageal reflux disease.

Gastric emptying in children with cerebral palsy and gastroesophageal reflux

2004 ◽  
Vol 31 (3) ◽  
pp. 177-182 ◽  
Author(s):  
Kleomenis Spiroglou ◽  
Ioannis Xinias ◽  
Nikolaos Karatzas ◽  
Elisa Karatza ◽  
George Arsos ◽  
...  
Keyword(s):  
Cerebral Palsy ◽  
Gastric Emptying ◽  
Gastroesophageal Reflux ◽  
Children With Cerebral Palsy
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