Gastrointestinal manifestations in children with cerebral palsy

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 fun ctional or structural abnormalities. Furthermore, we tried to correlate the type of GI dysfunction with findings on computed tomography (CT) or magnet ic resonance imaging (MRI) of the brain. Our results showed that 92% of chi ldren with cerebral palsy had clinically significant gastrointestinal sympt oms. Swallowing disorders were present in 60% of patients, regurgitation an d/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 gast roesophageal reflux, 41 (91%) had an abnormal pH-monitoring and/or esophagi tis. 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 col on and rectum in 9 (36%) and in 3 (12%) at level of the rectum only. Comput ed tomography and/or magnetic resonance imaging were normal in 5 (9%) and a bnormal in 53 (91%) of the 58 children with cerebral palsy. No GI symptom w as significantly associated with any kind of abnormal neuroimaging. In conclusion, children with cerebral palsy exhibited diffuse GI clinical m anifestations, mostly due to disorders of GI motility. The GI symptoms seem ed not to be related to any specific finding on CT or MRI of the brain. (C) 1999 Elsevier Science B.V. All rights reserved.