Gastrointestinal Disorders in Neurologically Impaired Children
In neurologically impaired children dysphagia, gastroesophageal reflux (GER), and obstipation pose frequent conditions with an impressive impact on patients’ comfort and behavior. These conditions are often diagnosed late due to deficits in communicating the pain and discomfort resulting from them. Knowledge of signs and symptoms and understanding of the mechanism leading to these conditions will lead to timely, earlier recognition and therapy. Thus, health and quality of life of these special patients and their caregivers or parents may be improved impressively. Impairment of the motility control of the gut as well as typical factors like inadequate food and fluid intake, frequent supine position and the use of some medications pose a risk to disturb the motility of the gastrointestinum. Dysphagia can be caused by acute onset of intra-cranial hemorrhage, cerebral infarction, or traumatic injuries. It can be the result of congenital and chronic disorders or diseases: intracranial tumors, cerebral palsy, genetic disorders, encephalopathy, or neuropathy. In dysphagia, there is a permanent risk of aspirations while eating or drinking, and it may lead to refusal of oral intake and extreme duration of feeding. Once recognized by typical symptoms, fluoroscopy, and physical assessment, therapy has to be multidisciplinary with adaption of diet, eventually performing a percutaneous endoscopic gastrostomy to secure food intake, training with the speech therapist and occupational therapist. GER results from a disturbed function of the lower esophageal sphincter and the esophageal cleaning mechanism, which pose the barrier function. It frequently leads to pulmonary aspirations, damage to the esophageal mucosa, pain, and changes in behavior. Diagnosis is assessed via endoscopy, impedance pH monitoring, and contrast study. When recognized, therapy consists of changes in diet as well as in administration of acid-reducing drugs and mucosal-protecting drugs. In severe cases, fundoplication can lead to an impressive improvement of health and quality of life. Obstipation results from being nonambulatory, low fluid intake, and some frequently used medications of neurologically impaired children as well as from disturbed colonic motility. Its importance for well-being is often underestimated. Once recognized, therapy consists in physical training if possible, special diet, and administering of stool softening and peristalsis enhancing drugs after clearance of the entire colon. In severe cases, a Malone procedure for antegrade enemas can be extremely helpful.
KeywordsGastric Emptying Cerebral Palsy Gastroesophageal Reflux Lower Esophageal Sphincter Percutaneous Endoscopic Gastrostomy
Gastroesophageal reflux disease
Neurologically impaired patients
Percutaneus endoscopic gastrostomy