Gastrointestinal and nutritional problems in neurologically impaired children

Abstract

Fax: + 44 20 7813 8382Gut Motility disorders comprise a heterogeneous group of disorders that result from disruption of the functional integrity of the intrinsic neuromusculature of the gastrointestinal (GI) tract. This intrinsic neuromusculature includes the smooth muscle layers, the intrinsic nervous system of the GI tract (enteric nervous system or ENS) and the interstitial cells of Cajal. The contribution of each of these components to function can be compromised by alterations in structure (ranging from absence to derangement in numbers and/or anatomy) or of function (complete or partial failure in physiological function). This pathology can be primary or secondary to a number of insults e.g. infections, inflammation, toxins etc. In children disorders may be congenital being present from birth or acquired later in life. Finally involvement of the enteric neuromusculature can be patchy/segmental or affect the gastrointestinal tract diffusely.Neuro-gastroenterology is the study of the interface of all aspects of the gastrointestinal tract or digestive system with the different branches of the body's nervous system including the enteric, central and autonomic nervous systems. The combined terms 'Neurogastroenterology and motility' are designed to encompass the study of all the components of the enteric neuromuscualture and their modulating influences and represents one of the fastest growing areas in gastroenterology clinical practice and research. This chapter aims to address some of the most common neurogastroenterology and motility conditions seen in clinical practice ranging from those with defined pathology to those which fall under the umbrella of functional gastrointestinal disorders. The latter comprise some of the commonest but challenging disorders and the term 'functional' reflects the fact that in the majority of such conditions no organic cause can be found. It should also be noted that at the present time many functional disorders e.g. abdominal pain-related functional GI disorders, represent symptom complexes that can further be subdivided into more discrete entities e.g. irritable bowel syndrome, functional abdominal pain etc depending on the nature, location and associations of the symptoms. Clinicians will often rely on the presence or absence of 'red flags' e.g. associated weight loss, severe or significant symptoms etc to decide whether patients are likely to have organic or functional disorders. Exhaustive investigations in the latter are likely to prove fruitless, expensive and perpetuate 'illness behaviours' in the patients. Abdominal pain-related functional gastrointestinal disorders IntroductionAbdominal pain-related functional gastrointestinal disorders (FGID) constitute a spectrum of conditions characterised by the presence of recurrent abdominal pain in the absence of any defined pathology 1 . In the past these disorders fell under the single term 'Recurrent abdominal pain' (RAP) but have since been recategorised under an international initiative (Rome Foundation) to improve the dia...

Percutaneous endoscopic gastrostomy experience in children and family satisfaction

“…When the distribution of 21 patients in this study was examined, it was seen that the patients with neurological problems (n=15, 71.4%) were in the first place. This situation is compatible with the large series published in the world 6,7 . In a study conducted in our country, it has been reported that children with neurological diseases take the first place among the patients with PEG in the childhood age group 4 .…”

Oral hygiene and oral status of institutionalized children with motor and intellectual disabilities

“…In children with swallowing dysfunction, such as that seen with intellectual disability, congenital nervous and muscular diseases, and CP, gastrostomy tube feeding is the preferred method for long-term enteral feeding since it is less obtrusive than a nasogastric tube [15,16]. Neurologically impaired children frequently experience gastro-esophageal reflux disease (GERD), which may cause recurrent chest infections and recurrent vomiting, and GERD can occur whether children are tube-fed or not [17]. Although children who are tube-fed, especially those with gastrostomy and jejunostomy tube feeding, may appear as if they do not need plaque control, they often develop GERD and are at greater risk for aspiration pneumonia due to accumulated debris and oral microorganisms [15,17,18].…”

“…Neurologically impaired children frequently experience gastro-esophageal reflux disease (GERD), which may cause recurrent chest infections and recurrent vomiting, and GERD can occur whether children are tube-fed or not [17]. Although children who are tube-fed, especially those with gastrostomy and jejunostomy tube feeding, may appear as if they do not need plaque control, they often develop GERD and are at greater risk for aspiration pneumonia due to accumulated debris and oral microorganisms [15,17,18].…”

Epidemiology of gastrostomy insertion for children and adolescents with intellectual disability

“…Gastrostomy is one management option to improve daily feeding regimens, long-term nutrition and medication administration [8]. It is used across a range of indications [9][10][11][12][13] but children with neurological impairments have more frequent use [6,11,12,14] including a substantial proportion who have ID [15].…”