Digestive tract neural control and gastrointestinal disorders in cerebral palsy

Abstract

Objectives: To examine the neural control of digestive tract and describe the main gastrointestinal disorders in cerebral palsy (CP), with attention to the importance of early diagnosis to an efficient interdisciplinary treatment.Sources: Systematic review of literature from 1997 to 2012 from Medline, Lilacs, Scielo, and Cochrane Library databases. The study included 70 papers, such as relevant reviews, observational studies, controlled trials, and prevalence studies. Qualitative studies were excluded. The keywords used were: cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation, recurrent respiratory infections, and gastrostomy. Summary of the findings:The appropriate control of the digestive system depends on the healthy functioning and integrity of the neural system. Since CP patients have structural abnormalities of the central and peripheral nervous system, they are more likely to develop eating disorders. These range from neurological immaturity to interference in the mood and capacity of caregivers. The disease has, therefore, a multifactorial etiology. The most prevalent digestive tract disorders are dysphagia, gastroesophageal reflux disease, and constipation, with consequent recurrent respiratory infections and deleterious impact on nutritional status. Conclusions:Patients with CP can have neurological abnormalities of digestive system control; therefore, digestive problems are common. The issues raised in the present study are essential for professionals within the interdisciplinary teams that treat patients with CP, concerning the importance of comprehensive anamnesis and clinical examination, such as detailed investigation of gastrointestinal disorders. Early detection of these digestive problems may lead to more efficient rehabilitation measures in order to improve patients' quality of life.J Pediatr (Rio J). 2012;88(6):455-64: Cerebral palsy, dysphagia, gastroesophageal reflux disease, constipation. ResumoObjetivos: Abordar as peculiaridades do controle neuronal digestório e descrever as principais manifestações digestórias na paralisia cerebral, atentando-se à importância do diagnóstico precoce para intervenção interdisciplinar eficaz. Fontes dos dados:Revisão sistemática de 1997 a 2012 das bases de dados MEDLINE, LILACS, SciELO e Cochrane Library. Incluem-se 70 artigos, como revisões relevantes, estudos observacionais, ensaios clínicos e estudos de prevalência. Excluíram-se pesquisas qualitativas. Os termos pesquisados foram: paralisia cerebral, disfagia, doença do refluxo gastroesofágico, constipação intestinal, infecção respiratória e gastrostomia. Síntese dos dados:O controle adequado do trato digestório depende do funcionamento e integridade do sistema nervoso. Como indivíduos portadores de paralisia cerebral possuem anormalidades estruturais evidentes no sistema nervoso central e periférico, estão mais propensos a desenvolver distúrbios do trato digestório, com repercussões nutricionais. As alterações vão desde imaturidade neurológica até interferência do estado d...

Cerebral palsy dysphagia: a systematic review

“…The damage is not progressive and it weakens in a variable way the coordination of the muscular action, resulting in the child's inability to maintain postures and to perform normal movements, being able, with the passage of time, to have changes in its clinical manifestations. It is classified by the body location of the neuromotor impairment, and the most common are tetraparesis, hemiparesis and paraparesis, and by type of tonus and posture alteration: athetoid, ataxic, hypotonic, spastic (corresponding to about 80% of cases) and mixed [1][2][3] . The major cause of CP is perinatal anoxia due to abnormal or prolonged labor.…”

“…Among the most frequently encountered difficulties are dysphagia for solids and liquids, regurgitations and vomiting, prolonged time to offer the meal and intestinal constipation. These manifestations are considered risk factors for eating disorders: by the motor alteration of the oropharyngeal dynamics; lack of understanding of the alimentary context and difficulty in the voluntary motor action of the oral phase, being able to alter the sequencing of the pharyngeal phase; and by the severity of pulmonary aspiration 3 .…”

“…It is necessary that caregivers and professionals be attentive monitoring the first symptoms of food difficulties. High digestive alterations may trigger nutritional deficits and problems in the growth curve, greater number of hospitalizations and the need for gastrostomy 3,4 .…”

A Survey on Growth and Nutritional Status of Children with Cerebral Palsy in the Northwest Iran

“…It was suggested that feeding difficulties can interfere with the calorie intake required for the energy needs of children; thereby, it probably results in a decrease of the linear growth and a serious risk of malnutrition (9,19). Multiple etiologies such as motor disability, inadequate nutritional intake, and motor dysfunction were suggested as the factors causing malnutrition in children with CP (6)(7)(8). Inadequate nutrition may increase healthcare costs and limit functional mobility, particularly in children with severe motor impairments (21,25,26).…”

“…As previously described (6)(7)(8), due to oral motor dysfunction, gastroesophageal reflux, and food refusal, the total caloric intake of children with CP is inadequate, which results in undernourishment and growth impairment. Neurological impairment along with malnutrition and low caloric intake may lead to slow linear growth and weight gain, which accompanies the lower height and weight in children with CP, compared with their healthy counterparts (9,10).…”