REVISÃO
Gastrostomia e refluxo gastroesofágico em crianças neuropatas
Gastrostomy and gastroesophageal reflux in neurologically impaired children
Giovanni Cappellano
1ABSTRACT
Gastrostomy has been increasingly indicated for daily feeding of neurologically impaired children with swallowing abnormalities that hinder the use of the mouth. Therefore, the enteral route has still been used by means of oral, nasogastric or nasojejunal tube.
However it is no longer the preferential method, mainly in cases of prolonged use. Today gastrostomy is the most often utilized procedure, particularly Stamm gastrostomy. Many of these patients present pulmonary abnormalities due to a possible gastroesophageal reflux (GER). After the study by Jolley et al.
(1), in 1985, fundoplication has become a systematic and routine complement to gastrostomy. The neurologically impaired patients have been submitted to two surgeries, leading to possible and predictable increase in morbidity and mortality rates. Although effective when properly indicated, this simple management has recently been very much debated and rejected. Thus, an updating based on recent studies is necessary to make pediatric surgeons and pediatricians aware of other manners to solve this problem, which aim at correctly feeding these children with impaired swallowing and GER and helping them have a better quality of life.
The literature reviewed was searched in PubMed/Medline, from January 1994 to May 2003. Other articles read and mentioned in this review and published before 1994 were collected based on articles cited in the references. Thus, we could assess the chronological progression in management of neurologically impaired children who need gastrostomy for their feeding, and carry out an analysis of current fundoplication and the question whether the use of a prophylactic antireflux valve is compulsory or not.
Keywords: Gastrostomy; Gastroesophageal reflux; Gastroplasty;
Nervous system diseases; Child; Review literature
RESUMO
Cada vez mais freqüente é a indicação de gastrostomia para alimentação diária em crianças neuropatas com alterações na deglutição que impossibilitam o uso da via oral. Para tanto, era e ainda é usada a via enteral, através de sonda oro ou nasogástrica, ou nasojejunal. Atualmente, porém, não parece ser o método preferencial, principalmente quando essa via de alimentação for de uso prolongado. O procedimento mais utilizado hoje em dia é a
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