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OCMW --- Cliënt --- MW --- OCMW, Oostende

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Stofwisselingsziekten --- Troubles du métabolisme --- Genetische ziekten --- Kinder- en jeugdpsychiatrie --- Kindergeneeskunde --- metabolische ziekten --- 605.16 --- 605.2 --- aangeboren afwijkingen --- fenylketonurie --- geneeskunde --- gezondheidszorg --- kinderen --- pediatrie --- 616.007 --- Aangeboren afwijkingen (aicardi syndroom, congenitale afwijkingen, Silver-Russell syndroom, Smith-Lemli-Opitz-syndroom, syndroom van Sturge-Weber) --- Fenylketonurie --- Borstvoeding --- Voedingsdriehoek --- Ziekten (darm) en voeding --- Zwangerschap en voeding --- Maladies génétiques --- Pédopsychiatrie --- Pédiatrie --- Maladies métaboliques --- Stofwisselingsziekten - Endocrinologie --- Kindergeneeskunde - Pediatrie

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Objective: Upper esophageal sphincter (UES) opening dysfunction has a wide range of underlying pathophysiologies. An accurate diagnosis of these pathophysiologies is critical for providing appropriate treatment, which can prevent aspiration and reduced material passing into the esophagus. The aim of this study is to explore the relationship between high resolution manometry impedance (HRMI) and videofluoroscopy (VFSS) in the evaluation of UES opening. Material & methods: 117 patients (65 M) with suspicion of UES opening dysfunction were enrolled in this study. A Swallow GatewayTM analysis of 10 ml liquid swallows was performed based on pressure flow analysis (PFA) metrics and compared to VFSS assessment. Results: We found that maximum admittance and pharyngeal peak pressure on HRMI correlated strongly to UES opening on VFSS. A significant negative correlation was shown between the PFA metric bolus presence time and UES opening on radiology. In this study, more patients with a UES opening dysfunction were detected using impedance than when using VFSS. PAS scores corresponded variably with swallow risk index (SRI), UES integrated relaxation pressure (IRP) and maximum admittance. Decreased maximum admittance and increased UES IRP, while no aspiration was detected on VFSS, occurred in respectively 23.93% and 45.30% of the patients. In 8.55% of the patients aspiration occurred, despite a normal SRI. Discussion: There seems to be some correspondence between HRMI and VFSS. However, we only examined UES opening in patients who swallow 10 ml liquid boluses. When looking at different consistencies and volumes, it is possible other results will arise.

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Aim: This scoping review aims to provide an overview of existing feeding readiness tools and validation of these tools in preterm infants. Therapy combined with feeding readiness tools and transition time from gavage feeding to full oral feeding are discussed. Methods: A search strategy for PubMed was devised based on three concepts: feeding readiness, preterm infants, and tools/assessment. Blind selection was performed in two steps (title/abstract and full text) by two independent evaluators. Conflict resolution was executed by a third independent evaluator. Evaluation criteria include the study objective, population, language, type of literature and publication date. References of the included articles and secondary literature were evaluated. Results: After selection of the 4451 extracted articles, 32 articles were included. Eight feeding readiness tools were identified. Thirty articles discussed validation of these tools. Only three articles evaluated therapy in combination with the tools. No articles evaluated the transition from gavage feeding to full oral feeding. Discussion: The evidence for validation of the feeding readiness tools was limited. Universal guidelines concerning validation of tools for the paediatric and preterm population appear to be beneficial for future research. Implementation of feeding readiness tools seems to be an added value to the standard of care.

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Background and aims: Flow across the EGJ is mainly determined by its distensibility in response to increased intraluminal pressure. Indeed, it has been shown that EGJ distensibility correlates with stasis and symptoms in healthy volunteers and patients with achalasia. Recently, integrated pressure-flow analysis (PFA), was developed to derive novel measures designed to quantify bolus transport. In the present study, therefore, we investigate the correlation between distensibility measurement of the EGJ and PFA analysis. Methods: We measured distensibility of the EGJ using an endoscopic functional luminal imaging probe (EndoFLIP®) in 16 achalasia patients (m=9, age 52.6±3.8). Patients were also assessed by HRIM and PFA analysis was performed. At the same time a timed barium esophagogram was performed and symptom scores were assessed using the Eckardt score, with a score <4 indicating treatment success. The relation between distensibility, PFA parameters (Distention pressure during emptying (DPE), Impendance ratio (IR) and EGJ relaxation (IRP4)) and esophageal stasis and symptoms scores was analyzed. Results: In total, 37 concurrent EndoFLIP® and PFA studies were compared. Baseline EGJ distensibility was impaired in all patients (mean 0.8±0.1 mm2/mmHg at 40 ml volume distension, n=13). Moreover a significant correlation with Eckardt (r=-0.6, p<0.0001, Pearson’s correlation) and stasis (r=-0.4, p=0.009, Pearson’s correlation) was present. Also DPE was impaired at baseline (mean 30.1±5.1 mmHg). DPE was also significantly correlated with Eckardt score (r=0.5, p=0.003, Pearson’s correlation) and stasis (r=0.5, p=0.002, Pearson’s correlation). Moreover a significant correlation between distensibility and DPE was present (r=-0.37, p=0.03, Pearson correlation). No correlation was found with IRP4 or IR. Conclusion: EGJ distensibility is impaired in patients with achalasia and is associated with esophageal emptying and clinical response. This can be objectified using the PFA metric DPE ,which correlated significantly with esophageal emptying om RX, clinical symptoms and EGJ distensibility using endoFLIP. Therefore, we conclude that pressure flow analysis can be used as an alternative for EndoFLIP® measurement in the evaluation of achalasia patients.