欧洲儿科胃肠病学、肝病学和营养学会关于神经功能障碍儿童胃肠道和营养并发症评估与治疗的指南

European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment.

作者信息

Romano Claudio, van Wynckel Myriam, Hulst Jessie, Broekaert Ilse, Bronsky Jiri, Dall'Oglio Luigi, Mis Nataša F, Hojsak Iva, Orel Rok, Papadopoulou Alexandra, Schaeppi Michela, Thapar Nikhil, Wilschanski Michael, Sullivan Peter, Gottrand Frédéric

机构信息

*Unit of Pediatrics, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy †Department of Paediatric Gastroenterology, Hepatology and Nutrition, Ghent University Hospital, Ghent, Belgium ‡Department of Pediatric Gastroenterology, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands §Department of Pediatric Gastroenterology, Faculty of Medicine, University Children's Hospital, University of Cologne, Cologne, Germany ||Department of Paediatrics, University Hospital Motol, Prague, Czech Republic ¶Department of Digestive Endoscopy and Surgery, Bambino Gesù Children's Hospital, Rome, Italy #Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital Ljubljana, Ljubljana, Slovenia **Children's Hospital Zagreb, Zagreb, Croatia ††University Children's Hospital Ljubljana, Ljubljana, Slovenia ‡‡Division of Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, University of Athens, Children's Hospital "Agia Sofia", Athens, Greece §§Pediatric Center, Clinic des Grangettes, Geneva, Switzerland ||||Department of Pediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom ¶¶Pediatric Gastroenterology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel ##Department of Paediatrics, Children's Hospital, University of Oxford, Oxford, United Kingdom ***Department of Pediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, University Lille, Lille, France.

出版信息

J Pediatr Gastroenterol Nutr. 2017 Aug;65(2):242-264. doi: 10.1097/MPG.0000000000001646.

DOI:10.1097/MPG.0000000000001646

PMID:28737572

Abstract

OBJECTIVES

Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment.

METHODS

Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the 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 applied to support the recommendations where no randomized controlled trials were available.

摘要

目的

喂养困难在神经功能障碍儿童中很常见，可能与营养不良、生长发育迟缓、微量营养素缺乏、骨质减少及营养合并症有关。胃肠道问题，包括胃食管反流病、便秘和吞咽困难，在该人群中也很常见，会影响生活质量和营养状况。目前缺乏针对这些患者护理的系统方法。通过本报告，欧洲胃肠病学、肝病学和营养学会旨在制定统一指南，以管理神经功能障碍儿童的胃肠病学和营养问题。

方法

针对神经功能障碍儿童常见胃肠和营养问题的诊断、治疗及预后，提出了31个临床问题。这些问题旨在评估营养管理，包括营养状况、识别营养不良、监测营养状况及确定营养需求；对胃肠道问题进行分类，包括口咽功能障碍、运动和感觉功能、胃食管反流病和便秘；评估营养康复的指征，包括肠内喂养和经皮胃造口术/空肠造口术；确定手术干预的指征（如nissen胃底折叠术、食管胃断流术）；最后考虑与严重神经功能障碍儿童消化和营养问题相关的伦理问题。使用MEDLINE对1980年至2015年10月的文献进行了系统检索。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表决。在没有随机对照试验的情况下，采用专家意见来支持这些建议。