Original Article Efficacy and tolerance of gastrostomy feeding in Duchenne muscular dystrophy L. Martigne a, * , D. Seguy b , N. Pellegrini c , D. Orlikowski c , J.-M. Cuisset d , A. Carpentier e , V. Tiffreau f , D. Guimber a , F. Gottrand a a Unite´deGastroente´rologie,He ´patologie et Nutrition Pe ´diatriques, Centre Hospitalier Re´gional et Universitaire de Lille, 59037 Lille, France b Service de Nutrition, Ho ˆpital Huriez, Centre Hospitalier Re ´gional et Universitaire, Lille, France c Unite´ de Re ´animation Me´dico-chirurgicale, Centre de re ´fe ´rence des maladies neuromusculaires, Garches, Necker, Mondor, Hendaye, Ho ˆpital Raymond Poincare ´, Centre Hospitalier Universitaire AP-HP, Garches, France d Service de Neurope´diatrie, Centre de Re´fe ´rence des Maladies Neuromusculaires, Ho ˆpital Salengro, Centre Hospitalier Re´gional et Universitaire, Lille, France e Centre de Re ´e ´ducation Fonctionnelle Marc Sautelet, Villeneuve d’Ascq, France f Service de Me ´decine Physique et de Re ´adaptation, Centre de Re ´fe ´rence des Maladies Neuromusculaires, Ho ˆpital Swynghedauw, Centre Hospitalier Re ´gional et Universitaire, Lille, France article info Article history: Received 24 December 2008 Accepted 22 June 2009 Keywords: Duchenne muscular dystrophy Undernutrition Nutritional status Enteral nutrition Gastrostomy Child summary Undernutrition occurs often in individuals with Duchenne muscular dystrophy (DMD). Between 1997 and 2007, a gastrostomy was placed in 25 patients with DMD (median: 23 years old; range,11–38 years) for weight loss (n ¼ 22) and/or swallowing disorders (n ¼ 13). We evaluated nutritional status using the weight-for-age (W/A) ratio, comparing the values to the reference curve for DMD patients. During the first 9 months, nutritional status improved: the W/A ratio increased and reached a plateau. The W/A ratio was 69% (range, 45–128%) at the start and increased to 87% (range, 49–164%) at the maximal follow-up of 22 months (P < 0.001). However, the W/A ratio did not reach the median value for age. Complications occurred in 21 patients (84%), but caused no mortality. Our data suggest that gastrostomy is well tolerated by, and effective for improving the nutritional status of, individuals with DMD. Ó 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. 1. Introduction Progress in the management of neuromuscular diseases has improved life expectancy, and an increasing number of patients with Duchenne muscular dystrophy (DMD) are living to adoles- cence and adulthood. Adolescents and adults with DMD frequently experience feeding difficulties and undernutrition 1,2 ; for example, the prevalence of undernutrition is 54% at 18 years of age. 2,3 It has been suggested that undernutrition can lead to trophic complica- tions and to a higher risk of lung infection due to weakness of the respiratory muscles 3 and lower immunity. 4,5 As oral caloric intake becomes difficult or dangerous because of swallowing disorders (dysphagia and tracheal aspirations) or as undernutrition persists despite caloric oral supplementation with thickened textures, enteral feeding becomes necessary. 6 Enteral nutrition can be delivered through a nasogastric tube or gastro- stomy. Gastrostomy is preferred for long-term enteral feeding in various conditions because it is well tolerated and easy to use, especially at home. 7,8 To our knowledge, there are few data about the benefits and complications of gastrostomy feeding in neuromuscular patients, 9–11 except for Ramelli et al’s study 12 (in heterogeneous neuromuscular disorders) and for patients with lateral amyotrophic sclerosis. 13,14 None was done in a large population of individuals with DMD. 2. Patients and methods Patient population: This was a retrospective multicenter study that took place under the umbrella of the Nutrition Group of the French Association against Myopathy. All French centers willing to contribute to the study were contacted. Three centers (Lille, Garches and Villeneuve d’Ascq) were selected because they had a significant number of patients who fulfilled the inclusion criteria (n > 5) and had exploitable files. Patients were eligible for the study if they had DMD and a gastrostomy placement during the past 10 years with at least 2 months of follow-up and available weight measurements. Twenty-five DMD patients (all boys), aged 11–38 years, had a gastrostomy by percutaneous endoscopic placement, Abbreviations: DMD, Duchenne muscular dystrophy; W/A ratio, weight-for-age ratio; GER, Gastroesophageal reflux. * Corresponding author. Tel.: þ33 3 20 44 61 26; fax: þ33 3 20 44 61 34. E-mail address: Leonie.MARTIGNE@CHRU-LILLE.FR (L. Martigne). Contents lists available at ScienceDirect Clinical Nutrition journal homepage: http://www.elsevier.com/locate/clnu 0261-5614/$ – see front matter Ó 2009 Elsevier Ltd and European Society for Clinical Nutrition and Metabolism. All rights reserved. doi:10.1016/j.clnu.2009.06.009 Clinical Nutrition 29 (2010) 60–64