Gastrostomy and enteral nutrition in neuromuscular diseases

Neuromuscular diseases (NMD) are disorders of often severe prognosis, and can easily lead to malnutrition. Swallowing disorders are frequent, and the patients can profit from enteral nutrition (EN), for which the way of election is gastrostomy. The aim of this review is to give a progress report on the evolution of NMD care since the 2000s for amyotrophic lateral sclerosis (ALS), the best explored disease, and for the other NMD. For ALS, percutaneous endoscopic gastrostomy (PEG) is the main method used, competed with because of its relative simplicity by radiological inserted gastrostomy (RIG). The indications are swallowing disorders, loss of weight, insufficient feeding, and difficulties of catching the meals. Current studies, not enough methodologically valuable, does not allow to affirm that EN improves survival of the patients nor their quality of life, but it could improve nutritional status. The complications after gastrostomy are aspecific, similar between PEG and RIG but the methods of evaluation are imprecise. The PEG is desirable if the patients forced vital capacity (FVC) is >50%. RIG is needed when FVC is <50%, after PEG failure or if the patients are in bad general condition. Documentation is limited for other NMD, including particularly child diseases and Duchenne muscular dystrophy (DMD). The indications and complications of gastrostomy are close to those of the ALS. EN improves patients nutritional status and, in DMD, quality of life. The families, the patients and the medical teams, often because of an insufficient communication, can be reserved considering nutrition support. (C) 2014 Elsevier Masson SAS. All rights reserved.