The Changes in Esophageal Acidity during Percutaneous Endoscopic Gastrostomy Feeding / 대한소화관운동학회지

BACKGROUND/AIMS: Generally, we try on nasogastric tube (NGT) feeding in brain-injury patients with impaired swallowing. It has been known that percutaneous endoscopic gastrostomy (PEG) tube feeding is less complicated than NGT feeding. However, there is no accurate report for gastroesophageal reflux as complication following PEG and NGT. Therefore, we measured esophageal acidity before and after changing NGT feeding into PEG feeding in management of brain-injury patients, and then evaluated the degree of gastroesophageal reflux. METHODS: Thirteen patients with impaired swallowing in brain-injury were included in this study. They all underwent NGT followed by PEG. Before and after PEG placement, 4 variables of acid exposure were evaluated with 24 hour ambulatory pH monitoring. RESULTS: Number of acid reflux episodes decreased in 5 cases. Number of long acid reflux episodes decreased in 3 cases. Total and fraction time pH below 4.0 decreased in 6 cases. There was no significant difference in improvement of acid reflux between before and after PEG feeding (p>0.05). CONCLUSIONS: Our data showed that acid reflux had a tendency to decrease in patients undergoing percutaneous endoscopic gastrostomy feeding, but it was increased in some of them.

The Incidence of Hyperparathyroidism in Renal Allograft Recipients with Stable Renal Function / 대한신장학회잡지

The hyperparathyroidism which causes renal osteodystrophy is a common complication in patients with end stage renal diseases. It is usually normalized after successful renal transplantation, but it remains in some renal transplant recipients. It is not well known whether hyperparathyroidism decreases bone mineral density in renal allograft recipients or not. To evaluate the incidence and predictive marker for hyperparathyroidism in renal allograft recipients and to describe the impact of hyperparathyroidism on the bone mineral density, we measured intact parathyroid hormone(iPTH) in 193 renal allograft recipients with stable renal and hepatic function. The mean age of patients was 42+/-12(13-76) years old and male female ratio was 1.9. The patients were on pre-transplant dialysis for 14.4+/-15.6(0-130) months and were followed up for 43.8+/-35.7(2-204) months after transplantation. Of the total 193 patients, 13 patients(6.7%) had high iPTH level. All patients showed normal serum calcium and phosphorous levels. iPTH levels were positively correlated to pre- and post-transplant serum alkaline phosphatase levels(vs. pre-transplant r=0.32, P<0.001, vs post- transplant r=0.63, P<0.001). There was no difference in pre- and post-transplant serum calcium, phosphorus, post-transplant serum creatinine and hemoglobin levels between the patients. There were no statistical differences in age, sex, duration of pre-transplant dialysis, duration of post-transplant follow-up, number of transplantation, donor type, primary renal disease and episodes of acute rejection. Of the total 193 patients, bone mineral density was studied in 37 patients. Bone mineral densities did not correlated to iPTH levels. In conclusion, the incidence of hyperparathyroidism in renal allograft recipients with stable renal function was 6.7%. Pre- and post-transplant serum alkaline phosphatase levels might be used as a useful marker for hyperparathyroidism. Serum iPTH level was not correlated to bone mineral density.