ABSTRACT
Gastrointestinal dysmotility is common in children and young people with neurodisabling conditions. In this article we seek to highlight the increasing difficulties faced by paediatricians in managing intestinal failure in this patient group. It is becoming clear that, as the median age for survival increases, intestinal failure is a significant problem, and can in some cases become life-limiting. The ethical issues around starting children with life-limiting conditions on parenteral nutrition (PN) are extremely complicated, not least because we are ignorant of the mechanism of intestinal failure in these children, and indeed, which of these children might be able to return to enteral feeding after a period of PN. Our article highlights these issues, drawing on our experience of a particularly difficult case, which we hope will stimulate further discussion among paediatricians providing care for children with neurodisabling conditions.
Subject(s)
Malabsorption Syndromes/etiology , Neurodevelopmental Disorders/complications , Adolescent , Colonic Diseases/etiology , Colonic Diseases/surgery , Enteral Nutrition , Gastrointestinal Motility , Humans , Intestinal Obstruction/etiology , Intestinal Obstruction/surgery , Malabsorption Syndromes/therapy , Male , Parenteral NutritionABSTRACT
OBJECTIVE: Gastrointestinal endoscopy is an invasive procedure used to diagnose and/or treat diseases of the gut. As with any invasive procedure, there is a small risk for complications, and it is therefore important that due consideration be taken when reviewing the indications for endoscopy, particularly in children. Despite this, there remains a wide variation nationally in clinical practice among paediatric gastroenterologists. In the absence of a standard, we critically reviewed current endoscopy practice at Addenbrooke's Hospital with the aim of creating robust measures that could be used to achieve and maintain an efficient, high-quality paediatric endoscopy service. Specifically, we assessed the proportion of referred patients undergoing endoscopy and the clinical outcomes of these procedures. DESIGN: A retrospective list of new clinic patients who had undergone endoscopy within 3 months of their appointment was obtained, dating from 1 January 2011 to 31 December 2011. Individual electronic medical records (eMR) records were reviewed for the type of endoscopy, indications, interval to procedure, histology findings, diagnoses, and impact on management. RESULTS: Out of the 674 children seen at clinic over the year, 17% (n=114) went on to have an endoscopic procedure; half of these patients underwent both upper endoscopy (i.e., oesophagogastroduodenoscopy) and colonoscopy. Out of the children who underwent colonoscopy, 43% (n=25) were confirmed to have inflammatory bowel disease. CONCLUSION: Our results provide a useful initial reference point against which other tertiary units can assess their own practice, with all striving to provide appropriate, efficient and cost-effective endoscopy services for children.
