Department of Gastroenterology, Women's and Children's Hospital, Women's & Children's Health Service, North Adelaide, SA, Australia.
JPEN J Parenter Enteral Nutr. 2012 Jan;36(1 Suppl):118S-23S. doi: 10.1177/0148607111428139.
Children with severe cerebral palsy (CP) commonly have gastrointestinal (GI) dysfunction. Whey-based enteral formulas have been postulated to reduce gastroesophageal reflux (GOR) and accelerate gastric emptying (GE). The authors investigated whether whey-based (vs casein-based) enteral formulas reduce GOR and accelerate GE in children who have severe CP with a gastrostomy and fundoplication.
Thirteen children received a casein-based formula for 1 week and either a 50% whey whole protein (50% WWP) or a 100% whey partially hydrolyzed protein (100% WPHP) formula for 1 week. Reflux episodes, gastric half-emptying time (GE t(1/2)), and reported pain and GI symptoms were measured.
Whey formulas emptied significantly faster than casein (median [interquartile range (IQR)] GE t(1/2), 33.9 [25.3-166.2] min vs 56.6 [46-191] min; P = .033). Reflux parameters were unchanged. GI symptoms were lower in children who received 50% WWP (visual analog symptom score, median [IQR], 0 [0-11.8]) vs 100% WPHP (13.0 [2.5-24.8]) (P = .035).
This pilot study shows that in children who have severe CP with a gastrostomy and fundoplication, GE of the whey-based enteral formula is significantly faster than casein. The acceleration in GE does not alter GOR frequency, and there appears to be no effect of whey vs casein in reducing acid, nonacid, and total reflux episodes. The results indicate that enteral formula selection may be particularly important for children with severe CP and delayed GE.
患有严重脑瘫（CP）的儿童通常存在胃肠道（GI）功能障碍。研究人员推测，乳清蛋白配方可减少胃食管反流（GOR）并加速胃排空（GE）。作者研究了胃造口和胃底折叠术治疗的严重 CP 儿童中，乳清基（与酪蛋白基）肠内配方是否可减少 GOR 并加速 GE。
13 名儿童接受酪蛋白配方 1 周，然后分别接受 50%乳清全蛋白（50%WWP）或 100%乳清部分水解蛋白（100%WPHP）配方 1 周。测量反流发作、胃排空半时间（GE t(1/2)）以及报告的疼痛和 GI 症状。
与酪蛋白配方相比，乳清配方排空速度明显更快（中位数[四分位间距（IQR）]GE t(1/2)，33.9[25.3-166.2]min 比 56.6[46-191]min；P=.033）。反流参数无变化。接受 50%WWP 的儿童 GI 症状较低（视觉模拟症状评分，中位数[IQR]，0[0-11.8]比 100%WPHP 13.0[2.5-24.8]；P=.035）。
这项初步研究表明，在胃造口和胃底折叠术治疗的严重 CP 儿童中，乳清基肠内配方的 GE 明显快于酪蛋白。GE 的加速并不改变 GOR 频率，乳清与酪蛋白在减少酸、非酸和总反流发作方面似乎没有差异。结果表明，对于 GE 延迟的严重 CP 儿童，肠内配方选择可能尤为重要。
