Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children

29 Jul

A large amount of what goes into a doctor’s decision making process is based on the communication between doctor and patient. How can you tell if someone has heartburn if you don’t understand the ways that person is communicating? Or, to put it more generally, how does the medical system appropriately serve those with difficulty communicating or with sensory issues?

This recent paper, Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children (full paper online), while not specific to autism, shows that with a lot of extra work, one can get valuable diagnostic information.

Here is the abstract:

Abstract

AIM:To investigate the effects of percutaneous endoscopic gastrostomy (PEG) feeding on gastro-oesophageal reflux (GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance (pH/MII).

METHODS: Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement.

METHODS: Prior to PEG placement (pre-PEG) a total of 183 GOR episodes were detected, 156 (85.2%) were non-acidic. After PEG placement (post-PEG) a total of 355 episodes were detected, 182 (51.3%) were non-acidic. The total number of distal acid reflux events statistically significantly increased post-PEG placement (pre-PEG total 27, post-PEG total 173, P = 0.028) and the mean distal pH decreased by 1.1 units. The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25 (0-2), post-PEG 2.95 (0-40)]. Average proximal pH was lower post-PEG but the within subject difference was not statistically significant (P = 0.058). Median number of non-acid GOR, average reflux height, total acid clearance time and total bolus clearance time were all lower pre-PEG, but not statistically significant.

CONCLUSION: PEG placement increases GOR episodes in neurologically impaired children.

It is a small study. They place feeding tubes in the children and measure acid events (GOR). The feeding tubes increase the number of acid events.

Gastrointestinal disease has been a major topic within the autism communities for some time. While most of the discussion tends to focus upon whether this is highly prevalent and whether this is somehow linked to autism causation, much less time has been focused upon the actual diagnosis and treatment. Doctors will need extra time and effort in order to make the diagnoses and treat individuals where communication is limited.

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3 Responses to “Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children”

  1. usethebrainsgodgiveyou July 30, 2011 at 19:22 #

    A kind post.

    Having suffered from gerd in the past and somehow gotten over it…It can be painful, What was ENORMOUSLY painful was after going off of Prilosec, it felt like my stomach was full of knives.

    To treat regardless of cause is only humane.

    One thing I have been concerned about lately is the toe-walking many of our kids have in common with ID, Schizophrenics, CP, Diabestes, and MD. Not a cause, either, but why does it appear so frequently?

  2. stanley seigler August 1, 2011 at 02:55 #

    [LBRB say] …to put it more generally, how does the medical system appropriately serve those with difficulty communicating or with sensory issues?

    thank for putting it more generally…”Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children” kinda lost me…

    how do the docs “appropriately serve”…tho we (for over 45 years) have received p-poor service…we have also received excellent, amazing service…one painfully obvious factor is the parent (care provider) being most sensitive to behaviors of the dear nonverbal child…eg,

    once our daughter was potty trained (at 13)…we figured out her going from one bathroom to another…was a sign of an urinary infection…

    so when this happened/happens…we advise the urologist and she prescribes an antibody…we do not have to wait for an appointment and lab results…

    of course we get an appointment and lab work to check for sure…but the antibody was started and the discomfort eliminated sooner.

    we now have good relationships with our daughters specialists and GP…BTW;

    when GP was asked (many years ago) if he would take care of our daughter…he said, “i would be honored.”… and her UCLA psychiatrist, who specializes in adolescent, sill see my daughter as he said he did not know anyone he could recommend.

    stanley seigler

  3. Alexandre Benedito Neves Rodrigues March 25, 2012 at 14:30 #

    A good working relationship between the surgeon, gastroenterologist, nurse, and patient’s family is essential to minimize long-term morbidity, particularly stoma-related problems.

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