Gastroenterological disorders and hepatic disease in adults with cerebral palsy: A systematic review

AIM: To describe the incidence, prevalence, and prognostic factors for gastroenterological disorders and hepatic disease in adults with cerebral palsy (CP), and to examine the effectiveness of any screening or interventions. METHOD: Six databases were searched for articles published in any language since 1990 meeting eligibility criteria, defined for each of five objectives. Two independent reviewers screened study titles, abstracts, and full texts for inclusion. RESULTS: Thirty-two reports of 30 unique samples, including 10 to 16 818 adults, were identified. Twenty-five reported prevalence of at least one of the following: gastroesophageal reflux disease (GERD) (prevalence 3%-42%; seven studies), constipation (4%-67%; seven studies), dysphagia (6%-77%; 12 studies), fecal incontinence (6%-29%; three studies), dental/oral cavity disorders (25%-53%; five studies), and aggregated hepatic diseases (1%-6%; seven studies). The prevalences of GERD, dysphagia, and hepatic disease were higher in adults with CP than in those without. The prevalence of fecal incontinence was greater in people classified as having CP in higher Gross Motor Function Classification System levels. No incidence studies were identified. Four intervention studies addressing oral/dental health or dysphagia were found, but certainty of evidence was low to very low. INTERPRETATION: The prevalence of specific gastroenterological disorders and hepatic disease varies across studies in adults with CP. Evidence for intervention efficacy in their management is of very low quality to absent.