Del Giudice E, Staiano A, Capano G, Romano A, Florimonte L, Miele E, Ciarla C, Campanozzi A, Crisanti A F
Department of Pediatrics, University Federico II, Naples, Italy.
Brain Dev. 1999 Jul;21(5):307-11. doi: 10.1016/s0387-7604(99)00025-x.
We describe the prevalence and nature of gastrointestinal (GI) symptoms in 58 children affected by cerebral palsy (range: from 6 months to 12 years of age) referred to a pediatric neurology outpatient clinic. In each patient we assessed (GI) symptoms and defined the associated GI functional or structural abnormalities. Furthermore, we tried to correlate the type of GI dysfunction with findings on computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Our results showed that 92% of children with cerebral palsy had clinically significant gastrointestinal symptoms. Swallowing disorders were present in 60% of patients, regurgitation and/or vomiting in 32%, abdominal pain in 32%, episodes of chronic pulmonary aspiration in 41% and chronic constipation in 74%. Dysfunction of the oral and/or pharyngeal phase of swallowing was found in 28 of 30 (93%) patients with swallowing disorders. Of the 45 patients with symptoms suggesting gastroesophageal reflux, 41 (91%) had an abnormal pH-monitoring and/or esophagitis. Furthermore, a significant delay in the scintigraphic gastric emptying of liquids was found in 12 of 18 patients (67%) and an abnormal esophageal motility in 11 of the 18 (61%) investigated patients. In 25 patients with chronic constipation evaluation of colonic transit showed a delay at level of the proximal segments of the colon in 13 (52%), at level of the left colon and rectum in 9 (36%) and in 3 (12%) at level of the rectum only. Computed tomography and/or magnetic resonance imaging were normal in 5 (9%) and abnormal in 53 (91%) of the 58 children with cerebral palsy. No GI symptom was significantly associated with any kind of abnormal neuroimaging. In conclusion, children with cerebral palsy exhibited diffuse GI clinical manifestations, mostly due to disorders of GI motility. The GI symptoms seemed not to be related to any specific finding on CT or MRI of the brain.
我们描述了58名患有脑瘫的儿童（年龄范围：6个月至12岁）的胃肠道（GI）症状的患病率及性质，这些儿童被转诊至一家儿科神经科门诊。我们评估了每位患者的（GI）症状，并确定了相关的GI功能或结构异常。此外，我们试图将GI功能障碍的类型与脑部计算机断层扫描（CT）或磁共振成像（MRI）的结果相关联。我们的结果显示，92%的脑瘫儿童有临床上显著的胃肠道症状。60%的患者存在吞咽障碍，32%有反流和/或呕吐，32%有腹痛，41%有慢性肺误吸发作，74%有慢性便秘。在30名有吞咽障碍的患者中，28名（93%）存在口腔和/或咽期吞咽功能障碍。在45名有胃食管反流症状的患者中，41名（91%）有异常的pH监测和/或食管炎。此外，18名患者中有12名（67%）液体闪烁扫描胃排空明显延迟，18名接受检查的患者中有11名（61%）食管动力异常。在25名有慢性便秘的患者中，结肠运输评估显示，13名（52%）在结肠近端节段有延迟，9名（36%）在左结肠和直肠水平有延迟，3名（12%）仅在直肠水平有延迟。58名脑瘫儿童中，5名（9%）的CT和/或MRI正常，53名（91%）异常。没有任何GI症状与任何类型的神经影像学异常显著相关。总之，脑瘫儿童表现出弥漫性的GI临床表现，主要是由于GI动力障碍。GI症状似乎与脑部CT或MRI的任何特定发现无关。
