欧洲儿科胃肠病、肝病和营养学会-北美儿科胃肠病、肝病和营养学会食管闭锁-气管食管瘘患儿胃肠道及营养并发症评估与治疗指南
ESPGHAN-NASPGHAN Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Esophageal Atresia-Tracheoesophageal Fistula.
作者信息
Krishnan Usha, Mousa Hayat, Dall'Oglio Luigi, Homaira Nusrat, Rosen Rachel, Faure Christophe, Gottrand Frédéric
机构信息
*Department of Pediatric Gastroenterology, Sydney Children's Hospital †Discipline of Pediatrics, School of Women's and Children's Health, University of New South Wales, Sydney, Australia ‡Division of Pediatric Gastroenterology, Rady Children's Hospital §San Diego School of Medicine, University of California, San Diego ||Digestive Endoscopy and Surgery Unit, Bambino Gesu Children's Hospital-IRCCS, Rome, Italy ¶Centre for Big Data Research in Health, University of New South Wales, Sydney, Australia #Aerodigestive Centre, Division of Gastroenterology and Nutrition, Boston Children's Hospital, Boston **Harvard Medical School, Harvard, MA ††Division of Pediatric Gastroenterology, Sainte-Justine Hospital ‡‡Department of Pediatrics, Université de Montréal, Montreal, Canada §§CHU Lille, University Lille, National Reference Center for Congenital Malformation of the Esophagus, Department of Pediatric Gastroenterology Hepatology and Nutrition, Lille, France.
出版信息
J Pediatr Gastroenterol Nutr. 2016 Nov;63(5):550-570. doi: 10.1097/MPG.0000000000001401.
BACKGROUND
Esophageal atresia (EA) is one of the most common congenital digestive anomalies. With improvements in surgical techniques and intensive care treatments, the focus of care of these patients has shifted from mortality to morbidity and quality-of-life issues. These children face gastrointestinal (GI) problems not only in early childhood but also through adolescence and adulthood. There is, however, currently a lack of a systematic approach to the care of these patients. The GI working group of International Network on Esophageal Atresia comprises members from ESPGHAN/NASPGHAN and was charged with the task of developing uniform evidence-based guidelines for the management of GI complications in children with EA.
METHODS
Thirty-six clinical questions addressing the diagnosis, treatment, and prognosis of the common GI complications in patients with EA were formulated. Questions on the diagnosis, and treatment of gastroesophageal reflux, management of "cyanotic spells," etiology, investigation and management of dysphagia, feeding difficulties, anastomotic strictures, congenital esophageal stenosis in EA patients were addressed. The importance of excluding eosinophilic esophagitis and associated GI anomalies in symptomatic patients with EA is discussed as is the quality of life of these patients and the importance of a systematic transition of care to adulthood. A systematic literature search was performed from inception to March 2014 using Embase, MEDLINE, the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Clinical Trials, and PsychInfo databases. The approach of the Grading of Recommendations Assessment, Development and Evaluation was applied to evaluate outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation, using the nominal voting technique. Expert opinion was used where no randomized controlled trials were available to support the recommendation.
背景
食管闭锁（EA）是最常见的先天性消化异常之一。随着手术技术和重症监护治疗的改进，这些患者的护理重点已从死亡率转移到发病率和生活质量问题。这些儿童不仅在幼儿期面临胃肠道（GI）问题，在青少年期和成年期也同样如此。然而，目前对这些患者的护理缺乏系统的方法。国际食管闭锁网络的胃肠工作组由欧洲儿科胃肠病、肝病和营养学会/北美儿科胃肠病、肝病和营养学会的成员组成，负责制定关于EA患儿胃肠道并发症管理的统一循证指南。
方法
针对EA患者常见胃肠道并发症的诊断、治疗和预后，提出了36个临床问题。涉及胃食管反流的诊断和治疗、“青紫发作”的管理、吞咽困难的病因、检查和管理、喂养困难、吻合口狭窄、EA患者先天性食管狭窄等问题。讨论了在有症状的EA患者中排除嗜酸性食管炎和相关胃肠道异常的重要性，以及这些患者的生活质量和系统的成人护理过渡的重要性。从创刊至2014年3月，使用Embase、MEDLINE、Cochrane系统评价数据库、Cochrane对照临床试验中心注册库和PsychInfo数据库进行了系统的文献检索。采用推荐分级评估、制定和评价方法来评估结果。在2次共识会议期间，对所有建议进行了讨论并最终确定。小组成员使用记名投票技术对每项建议进行投票。在没有随机对照试验支持该建议的情况下，采用专家意见。
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