Consumo alimentar de crianças e adolescentes com disfagia decorrente de estenose de esôfago: avaliação com base na pirâmide alimentar brasileira / Food consumption by children and adolescent with dysphagia due to esophageal stricture: assessment based on the Brazilian food guide pyramid

OBJETIVO: Avaliar o consumo alimentar de pacientes com disfagia decorrente de estenose de esôfago, comparando a dieta de consistência líquida com a dieta de consistência pastosa e sólida, com base na Pirâmide Alimentar Brasileira. MÉTODOS: Estudo de corte transversal, no qual foram incluídos consecutivamente 31 pacientes com estenose esofágica, sendo 18 (58,0 por cento) cáustica, 7 (22,6 por cento) pós-cirúrgica, 3 (9,7 por cento) péptica e 3 (9,7 por cento) sem causa definida. Empregou-se o recordatório de 24 horas; os alimentos foram transformados em porções em função dos oito grupos de alimentos, conforme recomendado por Philippi. Utilizou-se o teste Kruskal-Wallis e Exato de Fisher, fixando em 5 por cento o nível de rejeição da hipótese de nulidade. RESULTADOS: A idade variou entre 15 e 176 meses (mediana, 56 meses), sendo 28 crianças e três adolescentes, e 18 do sexo masculino. Vinte e nove pacientes (93,5 por cento) apresentavam disfagia, sendo grave em 34,4 por cento (10/29), moderada em 41,3 por cento (12/29), e leve em 24,1 por cento (7/29). O consumo mediano de porções de cereais, leguminosas, e óleos e gorduras foi menor no grupo com dieta líquida (p<0,005), o qual também apresentou maior proporção de pacientes cujo consumo foi abaixo do proposto pela pirâmide alimentar quando comparado ao grupo com dieta pastosa e sólida, com diferença estatisticamente significante (p<0,05). CONCLUSÃO: O suporte nutricional é de extrema importância no tratamento de pacientes com estenose esofágica, principalmente na disfagia grave, cuja dieta deve ser adaptada à consistência líquida, devido ao risco nutricional que se atribui à limitada ingestão alimentar, e para que o tratamento dietético seja precocemente instituído.

OBJECTIVE: This study assessed food intake by patients with dysphagia due to esophageal stricture and compared liquid, soft and solid diets based on the Brazilian Food guide pyramid. METHODS: This cross-sectional study consecutively included 31 patients with esophageal stricture, of which 18 (58.0 percent) were caustic, 7 (22.6 percent) were postoperative, 3 (9.7 percent) were peptic and 3 (9.7 percent) were of unknown etiology. The 24-hour dietary recall was used and the foods were converted into servings according to the eight food groups, as recommended by Philippi. The Kruskal-Wallis and Fisher's Exact Test were used and the significance level was set at 5 percent. RESULTS: The ages of the patients varied from 15 to 176 months (median: 56 months). There were 28 children and 3 adolescents, of which 28 were males. Twenty-nine patients (93.5 percent) presented dysphagia, of which 34.4 percent (10/29) were severe, 41.3 percent (12/29) were moderate and 24.1 percent (7/29) were mild. The median intake of grain, legume and fat servings was smaller in the liquid diet group (p<0.005). This group also had a significantly greater proportion of patients whose intakes were below those recommended by the food pyramid (p<0.05). CONCLUSION: Nutritional support is extremely important in the treatment of patients with esophageal stricture, especially those with severe dysphagia. These patients need a liquid diet because of the nutritional risk associated with inadequate food intake, which also allows early introduction of the dietary treatment.

Esophageal perforation in children: a review of one institution's experience.

BACKGROUND: The current approach to esophageal perforation treatment in children has shifted towards conservative management. However, the consensus of what constitutes conservative management is unclear, with various therapies and protocols described, including the need for various decompression and drainage procedures. Our institution utilizes conservative management with minimal intervention guided by the patient's clinical course. The purpose of this study is to report our management and add to the growing evidence for conservative management of esophageal perforation in children. METHODS: We performed a retrospective chart review of all patients with an ICD-9 diagnosis of esophageal perforation from January 1995 to July 2009. Patients with postoperative anastomotic leaks with drains in place were excluded, although patients with anastomotic leaks that were not controlled by drains were included. Data collected included patient demographics, etiology, diagnosis, treatment, complications, and outcome. RESULTS: Eight patients were identified who met inclusion criteria. Mean age was 28 mo (1 d-10 y), and the average time from causative event to diagnosis was 1.4 d (0-2 d). The etiology for esophageal perforation included esophagoscopy with dilation (n = 4), button battery ingestion (n = 1), coin ingestion (n = 1), nasogastric tube placement (n = 1), and leak after stricture resection (n = 1). All the patients were treated conservatively without primary surgery or thoracic drainage, and the mean time to perforation healing was 10.2 d (1-24 d). The average length of antibiotic therapy was 10 d (0-26 d). Enteral nutrition was utilized in five patients, and total parenteral nutrition (TPN) was utilized in five patients. No patient developed a new-onset esophageal stricture. CONCLUSION: Conservative management, guided by the patient's clinical course, with antibiotics and nutritional support is a safe and effective treatment for esophageal perforations in children.

Epidermolysis bullosa: management of esophageal strictures and enteric access by gastrostomy.

Epidermolysis bullosa (EB) is a spectrum of rare, inherited, blistering skin disorders, primarily affecting the skin and pharyngoesophageal mucosa. EB affects approximately 2 to 4 per 100,000 children each year. Blistering and scarring occur in response to even the most minor trauma. In this article, the authors outline the potential management options for patients with EB complicated by feeding difficulties secondary to esophageal strictures as well as those with nutritional deficiencies requiring a gastrostomy tube for supplemental feeding.

Successful medical treatment of two patients with eosinophilic oesophagitis.

BACKGROUND/PURPOSE: Significant oesophageal eosinophilia is associated with oesophagitis and gastroesophageal reflux (GER). Eosinophilic oesophagitis is a rare disease that causes thickening of the oesophageal wall, narrowing of the oesophageal lumen, and severe motor disturbance. METHODS AND RESULTS: Two 12 yr-old patients with eosinophilic oesophagitis were studied prospectively. Clinical and investigation details are presented. Elemental formula was administered until complete remission of disease. Final outcome was assessed after 3 months on regular diet with exclusion of specific allergic components. Both patients responded to the dietary manipulation. CONCLUSIONS: Eosinophilic oesophagitis must be included in the differential diagnosis when dealing with oesophageal strictures of unknown or unclear aetiology. Elimination diet therapy plays a crucial role in ameliorating the course of the illness. Blood eosinophilia correlates with therapeutic response and with improvement of the disease.

Tratamiento de las estenosis del esófago: experiencia del Hospital General de México / Treatment of the esophageal structures: experience in the Hospital General de Mexico

Presentamos nuestra experiencia en los procedimientos de dilatación del esófago, en los últimos diez años, un número elevado de pacientes han sido tratados con resultados muy satisfactorios en las estenosis de origen péptico o inflamatorio en general, resultados regulares en las estenosis originadas por la ingesta de substancias corrosivas y aceptables en las estenosis malignas del esófago, tomando en cuenta la índole y el pronóstico del padecimiento de base. Nuestra morbimortalidad es menor a la informada en la mayor parte de la literatura y el número de pacientes y procedimientos realizados es también mayor a lo publicado en series individuales.

Medical management of esophageal stricture in seven horses.

Esophageal strictures developed in 7 horses that were treated for esophageal obstruction. A soft diet was fed to all horses, with intermittent nasogastric tube feeding in one, and medication included nonsteroidal anti-inflammatory drugs. Maximal reduction in esophageal lumen diameter was evident by 30 days following circumferential esophageal ulceration, after which lumen diameter increased rapidly. Five horses were clinically normal by 60 days after the esophageal injury. Two horses were euthanatized at the owner's request, 16 and 17 days after the original insult.

[Diet in gastrointestinal diseases--1983 status]. / Diät bei Magen-Darm-Erkrankungen--Stand 1983.

In the treatment of gastrointestinal disease, no spectacular novelties have been introduced within the past few years. Dietary fibre, medium chain triglycerides (MCT) and certain formula diets have been established as standard tools in the treatment of various gastrointestinal diseases. Some progress has been noted with the introduction of longterm enteral feeding via needle catheter jejunostomies and longterm home parenteral nutrition. Study of the effects, use, practicability and cost of numerous "traditional" diets has led to a more realistic and critical prescription of diets. There is a general trend towards the prescription of diets only when their influence on the disease or on the abnormal nutritional state is superior to the effects of normal food.

Metabolic response to postoperative parenteral nutrition in infants.

Thirty-five infants who had tracheoesophageal fistula, esophageal stenosis, anal atresia, or Hirschsprung's disease were managed with various types of parenteral solution after their radical operations. The infants were divided into 6 groups and given 1) the usual low calorie infusion consisting of 5% glucose, water, and electrolytes, 2) high calorie formula consisting of 21 g/kg/day glucose, and 4 g/kg/day synthesized crystalline L-amino acids, 3) solutions without phosphate, 4) solutions of Cal/N ratio 200 providing 4 g/kg/day amino acids, 5) solutions of Cal/N ratio 400 providing 2 g/kg/day amino acids, and 6) a regimen containing fat emulsion. Nitrogen (N) and phosphorus (P) balances, blood urea nitrogen (BUN), blood glucose, plasma phosphate, immunoreactive insulin (IRI), and non-esterified fatty acid (NEFA) values were investigated. Parenteral solutions, providing 100 Cal/kg/day of Cal/N ratio 200, yielded sufficient positive N balance (120 mg/kg/day average). High calorie solutions without phosphate caused marked hypophosphatemia (0.3 mEq/1) with undetectable P in 24-hr urine. P balance correlated with N balance. Solutions of Cal/N 400 induced a lower BUN level, although there was a cumulative negative N balance. Solutions of Cal/N 200 induced higher levels of IRI and lower glucose than those of Cal/N 400. Increased IRI response and remarkedly decreased NEFA levels were seen in the group administered solutions without fat. Solutions with fat emulsion suppressed IRI response and improved the level of plasma NEFA.

[Intensive care and diet in cases of caustic esophageal stenosis after the first eight days]. / Réanimation et alimentation des sténoses caustiques de l'oesophage en dehors des huit premiers jours.

On the basis of 12 cases of caustic burns of the oesophagus, the authors describe the technique of alimentation, once the acute phase of the first eight days has passed. From the 8th to the 15th days, calories and provided parenterally. An upper GI series is carried out on the 15th day: if the stomach is healthy, the authors fashion an alimentation gastrostomy, if the stomach is damaged, they carry out gastrectomy with alimentation gastrostomy or jejunostomy. In all cases, continuity is re-established by coloplasty two months later.

[Surgical treatment of caustic esophagogastric stenosis in the chronic phase]. / Traitement chirurgical des sténoses Caustiques oeso-gastriques a la phase chronique.

The authors report the results of 26 oesophagoplasties carried out using the descending colon for oesophageal stenosis as a result of a caustic lesion. Superior: in 5 cases the anastomosis being made to the pharynx. Inferior: 8 associated gastric lesions being treated either by resection or by short circuit. The remaining oesophagus was removed in two cases. There were two postoperative deaths. In all the remaining patients a satisfactory functional result was obtained.