Mosiello Giovanni, Safder Shaista, Marshall David, Rolle Udo, Benninga Marc A
Department of Surgery, Division of Urology, Bambino Gesù Pediatric and Research Hospital, 00165 Rome, Italy.
College of Medicine, Center for Digestive, Health and Nutrition, Arnold Palmer Hospital for Children, Orlando, FL 32806, USA.
J Clin Med. 2021 Apr 13;10(8):1669. doi: 10.3390/jcm10081669.
Neurogenic/neuropathic bowel dysfunction (NBD) is common in children who are affected by congenital and acquired neurological disease, and negatively impacts quality of life. In the past, NBD received less attention than neurogenic bladder, generally being considered only in spina bifida (the most common cause of pediatric NBD). Many methods of conservative and medical management of NBD are reported, including relatively recently Transanal Irrigation (TAI). Based on the literature and personal experience, an expert group (pediatric urologists/surgeons/gastroenterologists with specific experience in NBD) focused on NBD in children and adolescents. A statement document was created using a modified Delphi method. The range of causes of pediatric NBD are discussed in this paper. The various therapeutic approaches are presented to improve clinical management. The population of children and adolescents with NBD is increasing, due both to the higher survival rate and better diagnosis. While NBD is relatively predictable in producing either constipation or fecal incontinence, or both, its various effects on each patient will depend on a wide range of underlying causes and accompanying comorbidities. For this reason, management of NBD should be tailored individually with a combined multidisciplinary therapy appropriate for the status of the affected child and caregivers.
神经源性/神经性肠道功能障碍（NBD）在患有先天性和后天性神经系统疾病的儿童中很常见，并且会对生活质量产生负面影响。过去，NBD受到的关注少于神经源性膀胱，通常仅在脊柱裂（小儿NBD最常见的病因）中才会被考虑。有许多关于NBD保守治疗和药物治疗的方法被报道，包括相对较新的经肛门灌洗（TAI）。基于文献和个人经验，一个专家小组（在NBD方面有特定经验的儿科泌尿科医生/外科医生/胃肠病学家）专注于儿童和青少年的NBD。使用改良的德尔菲法创建了一份声明文件。本文讨论了小儿NBD的病因范围。介绍了各种治疗方法以改善临床管理。患有NBD的儿童和青少年人数正在增加，这既是由于生存率提高，也是由于诊断更好。虽然NBD在导致便秘或大便失禁或两者兼有的情况方面相对可预测，但其对每个患者的各种影响将取决于广泛的潜在病因和伴随的合并症。因此，NBD的管理应根据受影响儿童和照顾者的状况，通过综合多学科治疗进行个体化定制。
