Long-term enteral feeding and gastroesophageal reflux disease in neurologically impaired children

Paola De Angelis, A. Pane, T. Caldaro, F. Torroni, G. Federici Di Abriola, G. Ciofetta, I. Aloi, A. Crocoli, F. Foschia, L. Dall'Oglio

Research output: Contribution to journalArticlepeer-review

Abstract

Background. In neurologically impaired children, feeding problems and gastroesophageal reflux disease require great care throughout the children's lifetimes. It is difficult to decide on the right time for diagnostic- therapeutic procedures. A vicious circle between gastroesophageal reflux disease, swallowing incoordination, and problems with aspiration leads to severe malnutrition, with poor quality of life. Objective. To retrospectively review a selected population and describe our management of these patients. Patients/methods. Neurologically impaired, malnourished patients (n = 261) underwent triceps skinfold thickness measurement, endoscopy/biopsy, and/or 24-hour pH-metry, videofluoroscopy-salivagram, upper gastrointestinal series, and gastric scintigraphy. The therapeutic options were chosen by a multidisciplinary team: percutaneous endoscopic gastrostomy, swallowing rehabilitation, Nissen fundoplication, pyloromyotomy (in delayed gastric emptying), total esophagogastric disconnection, EndoCinch, and/or gastrojejunal tube. Results. Surgical/endoscopic interventions chosen were 217 percutaneous endoscopic gastrostomies, 25 Nissen fundoplications/gastrostomies, 16 pyloromyotomies, 15 primary total esophagogastric disconnections, and 4 EndoCinch procedures. No operative mortality occurred; postoperative courses showed few complications. In the follow-up treatment, symptoms improved as did quality of life. Conclusion. Neurologically impaired children with gastroesophageal reflux disease, eating inability and malnutrition should be treated with rehabilitation planning, precocious gastrostomy, and early therapy for gastroesophageal reflux disease.

Original languageEnglish
Pages (from-to)147-152
Number of pages6
JournalNutritional Therapy and Metabolism
Volume25
Issue number3
Publication statusPublished - Jul 2007

Keywords

  • Enteral feeding
  • Gastroesophageal reflux disease (GERD)
  • Neurologically impaired children (NIC)

ASJC Scopus subject areas

  • Nutrition and Dietetics
  • Critical Care and Intensive Care Medicine

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