Incidence des troubles digestifs sur l'état respiratoire des enfants porteurs de handicap

Gastrointestinal manifestations are common in children with disability and concern more than 60% of them. They are involved in many complications, especially in respiratory disorders (persistent congestion, aspiration pneumonia). It is mainly the oromotor dysfunction (OMD) and the gastroesophageal reflux disease (GERD) sometimes associated to delayed gastric emptying, since they are source of oropharyngeal aspirations or pneumonia in case of massive GERD. The OMD is diagnosed during clinical examination and may require in some cases an exploration of swallowing. Its management mainly includes the modification of food texture. In severe forms prohibiting oral feeding, a gastrostomy is indicated. In case of DOM associated to severe GERD, antireflux surgery such as Nissen fundoplicature is coupled with gastrostomy. GERD is explored by 24 h pH monitoring if non-externalized. The upper digestive tract endoscopy is only indicated in case of suspected esophagitis. Only proton pump inhibitors had demonstrated efficacy in GERD and should be prescribed in combination with other measures such as right lateral decubitus positioning in some patients. Antireflux surgery is indicated in case of severe complicated GERD resistant to medical treatment. Due to their central role in respiratory complications, digestive disorders should be systematically investigated and managed to improve the quality of life of children with disabilities.