ABSTRACT
BACKGROUND: Aspiration is one of the major complications after percutaneous endoscopic gastrostomy (PEG). The administration of semi-solid nutrients by means of gastrostomy tube has recently been reported to be effective in preventing aspiration pneumonia. The effects of semi-solid nutrients on gastroesophageal reflux, intragastric distribution, and gastric emptying were evaluated. METHODS: Semi-solid nutrients were prepared by liquid nutrients mixed with agar at the concentration of 0.5%. The distribution of the administered radiolabeled liquid and semi-solid nutrients was monitored by a scintillation camera for 15 post-PEG patients. The percentage of esophageal reflux, the distribution of the proximal and distal stomach, and the gastric emptying time were evaluated. RESULTS: The percentage of gastroesophageal reflux was significantly decreased in semi-solid nutrients (0.82 +/- 1.27%) compared with liquid nutrients (3.75 +/- 4.25%), whereas the gastric emptying time was not different. The distribution of semi-solid nutrients was not different from liquid nutrients in the early phase, whereas higher retention of liquid nutrients in the proximal stomach was observed in the late phase. CONCLUSIONS: Gastroesophageal reflux was significantly inhibited by semi-solid nutrients. One of the mechanisms of the inhibition is considered to be an improvement in the transition from the proximal to distal stomach in semi-solid nutrients.
Subject(s)
Endoscopy, Gastrointestinal/adverse effects , Enteral Nutrition/methods , Gastroesophageal Reflux/prevention & control , Gastrostomy/adverse effects , Aged , Aged, 80 and over , Endoscopy, Gastrointestinal/methods , Female , Gastric Emptying , Gastroesophageal Reflux/complications , Gastrostomy/methods , Humans , Male , Pneumonia, Aspiration/etiology , Pneumonia, Aspiration/prevention & control , Radiopharmaceuticals , Technetium Compounds , Tin Compounds , ViscosityABSTRACT
BACKGROUND: It is difficult to predict whether or not gastroesophageal reflux (GER), such as aspiration or vomiting, will occur after PEG. OBJECTIVE: To identify factors that would support the prediction of aspiration after PEG. DESIGN: Case-control study. SETTING: Patients who underwent PEG from February 1998 to June 2005 in our hospital. PATIENTS: The study included 178 patients. INTERVENTIONS: Endoscopic observation was carried out during PEG tube placement and at PEG tube replacement to determine the presence of hiatus hernia and/or reflux esophagitis. MAIN OUTCOME MEASUREMENTS: Gastric emptying and GER index (GERI) were measured by using a radioisotope technique. RESULTS: The patients were divided into 2 groups: the non-GER (NGER) group (n = 108), who had no symptoms of GER, and the GER group (n = 70), who showed these symptoms. No significant differences were observed between the groups in age, sex, morbidity, the presence of reflux esophagitis at PEG tube placement, gastric emptying, or serum albumin levels. The presence of a hiatus hernia (P = .028) and reflux esophagitis grading Los Angeles classification C or D (P = .008) were significantly more frequent in the GER group compared with the NGER group. The GERI was also significantly higher in the GER group than in the NGER group (P < .0001). CONCLUSIONS: The presence of hiatus hernia, severe reflux esophagitis, and a high GERI might be predictive factors of aspiration or vomiting after PEG tube placement.
