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Gastrointestinal manifestations in children with cerebral palsy
E Del Giudice1, A Staiano, G Capano
1Department of Pediatrics, University Federico II, Naples, Italy. endelgiu@ds.unina.it
Insights
Gastrointestinal symptoms are highly prevalent in children with cerebral palsy, affecting 92%. These issues are primarily due to motility disorders, not specific brain imaging findings.
Area of Science:
- Pediatric Gastroenterology
- Pediatric Neurology
- Clinical Medicine
Background:
- Cerebral palsy (CP) often presents with complex health issues, including gastrointestinal (GI) dysfunctions.
- Understanding the prevalence and nature of GI symptoms in children with CP is crucial for improving their quality of life.
Purpose of the Study:
- To determine the prevalence and characteristics of GI symptoms in children with CP.
- To investigate associated GI functional or structural abnormalities.
- To explore potential correlations between GI dysfunction and neuroimaging findings (CT/MRI).
Main Methods:
- A cohort of 58 children with cerebral palsy (age 6 months–12 years) was assessed for GI symptoms.
- Evaluations included clinical assessment, pH-monitoring, esophagoscopy, scintigraphy, colonic transit studies, and neuroimaging (CT/MRI).
Main Results:
- 92% of children with CP experienced clinically significant GI symptoms.
- High prevalence of swallowing disorders (60%), chronic constipation (74%), and chronic pulmonary aspiration (41%).
- GI symptoms were largely attributed to motility disorders, with no significant association found between specific GI symptoms and neuroimaging results.
Conclusions:
- Children with cerebral palsy exhibit widespread GI clinical manifestations, predominantly stemming from GI motility disorders.
- The observed GI symptoms in this population do not appear to be linked to specific findings on computed tomography or magnetic resonance imaging of the brain.
Abstract:
We describe the prevalence and nature of gastrointestinal (GI) symptoms in 58 children affected by cerebral palsy (range: from 6 months to 12 years of age) referred to a pediatric neurology outpatient clinic. In each patient we assessed (GI) symptoms and defined the associated GI functional or structural abnormalities. Furthermore, we tried to correlate the type of GI dysfunction with findings on computed tomography (CT) or magnetic resonance imaging (MRI) of the brain. Our results showed that 92% of children with cerebral palsy had clinically significant gastrointestinal symptoms. Swallowing disorders were present in 60% of patients, regurgitation and/or vomiting in 32%, abdominal pain in 32%, episodes of chronic pulmonary aspiration in 41% and chronic constipation in 74%. Dysfunction of the oral and/or pharyngeal phase of swallowing was found in 28 of 30 (93%) patients with swallowing disorders. Of the 45 patients with symptoms suggesting gastroesophageal reflux, 41 (91%) had an abnormal pH-monitoring and/or esophagitis. Furthermore, a significant delay in the scintigraphic gastric emptying of liquids was found in 12 of 18 patients (67%) and an abnormal esophageal motility in 11 of the 18 (61%) investigated patients. In 25 patients with chronic constipation evaluation of colonic transit showed a delay at level of the proximal segments of the colon in 13 (52%), at level of the left colon and rectum in 9 (36%) and in 3 (12%) at level of the rectum only. Computed tomography and/or magnetic resonance imaging were normal in 5 (9%) and abnormal in 53 (91%) of the 58 children with cerebral palsy. No GI symptom was significantly associated with any kind of abnormal neuroimaging. In conclusion, children with cerebral palsy exhibited diffuse GI clinical manifestations, mostly due to disorders of GI motility. The GI symptoms seemed not to be related to any specific finding on CT or MRI of the brain.