Mahoney Lisa, Rosen Rachel
Aerodigestive Center, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, 300 Longwood Ave, Boston, MA 02115.
Paediatr Respir Rev. 2016 Jun;19:21-7. doi: 10.1016/j.prrv.2015.06.002. Epub 2015 Jun 24.
The current available literature evaluating feeding difficulties in children with esophageal atresia was reviewed. The published literature was searched through PubMed using a pre-defined search strategy. Feeding difficulties are commonly encountered in children and adults with repaired esophageal atresia [EA]. The mechanism for abnormal feeding includes both esophageal and oropharyngeal dysphagia. Esophageal dysphagia is commonly reported in patients with EA and causes include dysmotility, anatomic lesions, esophageal outlet obstruction and esophageal inflammation. Endoscopic evaluation, esophageal manometry and esophograms can be useful studies to evaluate for causes of esophageal dysphagia. Oropharyngeal dysfunction and aspiration are also important mechanisms for feeding difficulties in patients with EA. These patients often present with respiratory symptoms. Videofluoroscopic swallow study, salivagram, fiberoptic endoscopic evaluation of swallowing and high-resolution manometry can all be helpful tools to identify aspiration. Once diagnosed, management goals include reduction of aspiration during swallowing, reducing full column reflux into the oropharynx and continuation of oral feeding to maintain skills. We review specific strategies which can be used to reduce aspiration of gastric contents, including thickening feeds, changing feeding schedule, switching formula, trialing transpyloric feeds and fundoplication.
对目前评估食管闭锁患儿喂养困难的现有文献进行了综述。通过PubMed使用预定义的检索策略检索已发表的文献。喂养困难在食管闭锁（EA）修复后的儿童和成人中普遍存在。异常喂养的机制包括食管性和口咽性吞咽困难。食管性吞咽困难在EA患者中常见，其原因包括动力障碍、解剖病变、食管出口梗阻和食管炎。内镜评估、食管测压和食管造影是评估食管性吞咽困难病因的有用检查。口咽功能障碍和误吸也是EA患者喂养困难的重要机制。这些患者常出现呼吸道症状。电视透视吞咽研究、唾液造影、纤维内镜吞咽评估和高分辨率测压都是识别误吸的有用工具。一旦确诊，管理目标包括减少吞咽时的误吸、减少全柱反流至口咽以及继续经口喂养以维持技能。我们回顾了可用于减少胃内容物误吸的具体策略，包括增稠喂养、改变喂养时间表、更换配方奶、试行经幽门喂养和胃底折叠术。
