title: [Liver disease, gastrointestinal complications, nutritional management and feeding disorders in pediatric cystic fibrosis].
abstract: In cystic fibrosis (CF), approximately 5-8% of the patients develop multilobular cirrhosis during the first decade of life. Annual screening (clinical examination, liver biochemistry, ultrasonography) is recommended in order to identify early signs of liver involvement, initiate ursodeoxycholic acid therapy and detect complications (portal hypertension and liver failure). Management should focus on nutrition and prevention of variceal bleeding. The gut may also be involved in children with CF. Gastroesophageal reflux is frequent, although often neglected and should be investigated by pH monitoring and impedancemetry, if available. Acute pancreatitis occurs in patients with persistent exocrine pancreatic activity. Intussusception, appendicular mucocele, distal intestinal occlusion syndrome, small bowel bacterial overgrowth and Clostridium difficile colitis should be considered in case of abdominal pain. Preventive nutritional support should be started as soon as possible after diagnosis of CF. Attainment of normal growth is one of the main goals and can be achieved with hypercaloric and salt supplemented food. Pancreatic enzyme replacement therapy should be started as soon as exocrine pancreatic insufficiency is confirmed and ingested immediately prior to meals with intake of fat-soluble vitamins. Curative nutritional interventions are more likely to be effective in the early stages of pulmonary disease. Feeding disorders, related to the physiopathology and the psychologic aspects of the disease are frequent. Repeated corporeal aggressions, associated with inappropriate medical and parental pressure, may increase the child's refusal of food. The multidisciplinary team should guide parents in order to avoid all intrusive feeding practices and promote pleasant mealtimes.
authors.affiliation: Unité d'Hépatologie pédiatrique, APHP-CHU Necker-enfants malades, 75015 Paris, France.
authors.forename: D
authors.initials: D
authors.lastname: Debray
authors.affiliation: Unité de Gastroentérologie, Hépatologie, Nutrition, Diabétologie et Maladies Héréditaires du Métabolisme, Hôpital des Enfants, CHU de Toulouse, France; IRSD, Université de Toulouse, INSERM, INRA, ENVT, UPS, Toulouse, France.
authors.forename: E
authors.initials: E
authors.lastname: Mas
authors.affiliation: AP-HP, Hôpital Robert Debré, CRCM, Université Paris7, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Munck
authors.affiliation: AP-HP, Hôpital Robert Debré, CRCM, Université Paris7, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Gérardin
authors.affiliation: Unité de Gastroentérologie, Hépatologie et Nutrition Pédiatrique, CRCM pédiatrique, CIC1401 Hôpital des Enfants, CHU de Bordeaux, France. Electronic address: haude.clouzeau@chu-bordeaux.fr.
authors.forename: H
authors.initials: H
authors.lastname: Clouzeau
mesh_terms: D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003550:Cystic Fibrosis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy*; D004066:Digestive System Diseases / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D042241:Early Diagnosis; D061345:Early Medical Intervention; D019959:Feeding and Eating Disorders of Childhood / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007223:Infant; D033183:Interdisciplinary Communication; D000070516:Intersectoral Collaboration; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D010287:Parent-Child Relations