Inhibition of gastroesophageal reflux by semi-solid nutrients in patients with percutaneous endoscopic gastrostomy.

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.

[1]  H. Iizuka,et al.  Risk Factors for Aspiration Pneumonia after Percutaneous Endoscopic Gastrostomy , 2007, Gerontology.

[2]  Masaya Kubota,et al.  Clinical analysis of gastroesophageal reflux after PEG. , 2006, Gastrointestinal endoscopy.

[3]  E. Papageorgiou,et al.  Gastric emptying after semi–solid food in multiple system atrophy and Parkinson disease , 2005, Journal of Neurology.

[4]  M. Kuzuya,et al.  Prevention of Late Complications by Half-Solid Enteral Nutrients in Percutaneous Endoscopic Gastrostomy Tube Feeding , 2004, Gerontology.

[5]  Marilyn Schallom,et al.  Effect of gastrointestinal motility and feeding tube site on aspiration risk in critically ill patients: a review. , 2004, Heart & lung : the journal of critical care.

[6]  Hiroshi Shimokata,et al.  Prevention of Gastroesophageal Reflux Using an Application of Half‐Solid Nutrients in Patients with Percutaneous Endoscopic Gastrostomy Feeding , 2004, Journal of the American Geriatrics Society.

[7]  S. McClave,et al.  Complications of enteral access. , 2003, Gastrointestinal endoscopy.

[8]  T. Azuma,et al.  Effects of percutaneous endoscopic gastrostomy tube placement on gastric antral motility and gastric emptying , 2003, Journal of Gastroenterology.

[9]  M. Kuzuya,et al.  [Half-solid enteral nutrient prevents chronic complications of percutaneous endoscopic gastrostomy tube feeding]. , 2002, Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics.

[10]  D. Heyland,et al.  Effect of postpyloric feeding on gastroesophageal regurgitation and pulmonary microaspiration: Results of a randomized controlled trial , 2001, Critical care medicine.

[11]  Chi-Sen Chang,et al.  Can percutaneous endoscopic jejunostomy prevent gastroesophageal reflux in patients with preexisting esophagitis? , 2000, American Journal of Gastroenterology.

[12]  W. Crown,et al.  A national inpatient cost estimate of percutaneous endoscopic gastrostomy (PEG)-associated aspiration pneumonia. , 2000, The American journal of managed care.

[13]  F. Nicholson,et al.  Percutaneous endoscopic gastrostomy: A review of indications, complications and outcome , 2000, Journal of gastroenterology and hepatology.

[14]  K. Balan,et al.  Gastroesophageal reflux in patients fed by percutaneous endoscopic gastrostomy (PEG): detection by a simple scintigraphic method , 1998, American Journal of Gastroenterology.

[15]  M. Samsom,et al.  Gastrointestinal motor mechanisms in hyperglycaemia induced delayed gastric emptying in type I diabetes mellitus. , 1997, Gut.

[16]  R. Batey,et al.  Complications and outcome of percutaneous endoscopic gastrostomy in different patient groups , 1996, Journal of gastroenterology and hepatology.

[17]  Y. Kawaura,et al.  Gastric Emptying and Gastroesophageal Reflux in Patients Fed via Percutaneous Endoscopic Gastrostomy: Effects of Erythromycin , 1996 .

[18]  Jon B Morris,et al.  Long-term Enteral Access in Aspiration-prone Patients , 1995, Journal of intensive care medicine.

[19]  T. Peeters.  Erythromycin and other macrolides as prokinetic agents. , 1993, Gastroenterology.

[20]  J. Dent,et al.  Role of the proximal and distal stomach in mixed solid and liquid meal emptying. , 1991, Gut.

[21]  P. H. Patel,et al.  Risk factors for pneumonia after percutaneous endoscopic gastrostomy. , 1990, Journal of clinical gastroenterology.

[22]  G. Vantrappen,et al.  Improvement of gastric emptying in diabetic gastroparesis by erythromycin. Preliminary studies. , 1990, The New England journal of medicine.

[23]  R. Cogen,et al.  Aspiration pneumonia in nursing home patients fed via gastrostomy tubes. , 1989, The American journal of gastroenterology.

[24]  B. Krevsky,et al.  Biphasic nature of gastric emptying. , 1988, Gut.

[25]  E. Dimagno,et al.  Percutaneous endoscopic gastrostomy. Indications, success, complications, and mortality in 314 consecutive patients. , 1987, Gastroenterology.

[26]  E. Shaffer,et al.  Aspiration after percutaneous gastrostomy. Assessment by Tc-99m labeling of the enteral feed. , 1987, Journal of clinical gastroenterology.

[27]  I. Carrió,et al.  Gastric emptying of solid and liquid meals in healthy young subjects. , 1984, Scandinavian journal of gastroenterology.

[28]  J. Ponsky,et al.  Percutaneous endoscopic jejunostomy. , 1984, The American journal of gastroenterology.

[29]  C. Pope,et al.  Gastric emptying and gastroesophageal reflux. Effects of surgery and correlation with esophageal motor function. , 1982, American journal of surgery.

[30]  J. Richter,et al.  Gastroesophageal Reflux: Pathogenesis, Diagnosis, and Therapy , 1982 .

[31]  R. McCallum,et al.  Gastric emptying in patients with gastroesophageal reflux. , 1981, Gastroenterology.

[32]  J. Ponsky,et al.  Percutaneous endoscopic gastrostomy: a nonoperative technique for feeding gastrostomy. , 1981, Gastrointestinal endoscopy.

[33]  J. Ponsky,et al.  Gastrostomy without laparotomy: a percutaneous endoscopic technique. , 1980, Journal of pediatric surgery.

[34]  P. Tothill,et al.  Gastric emptying rate measurement in man. A double isotope scanning technique for simultaneous study of liquid and solid components of a meal. , 1976, Gastroenterology.

[35]  John C. Fang,et al.  Minimizing endoscopic complications in enteral access. , 2007, Gastrointestinal endoscopy clinics of North America.

[36]  E. Thomas,et al.  Prevalence of gastroesophageal reflux in patients who develop pneumonia following percutaneous endoscopic gastrostomy: A 24-hour pH monitoring study , 2004, Dysphagia.

[37]  L. Rabeneck,et al.  Long-term outcomes of patients receiving percutaneous endoscopic gastrostomy tubes , 1996, Journal of general internal medicine.

[38]  A. Weintraub,et al.  Gastroesophageal reflux during gastrostomy feeding. , 1994, Gastroenterology.

[39]  M. Shike,et al.  Direct percutaneous endoscopic jejunostomies. , 1991, Gastrointestinal endoscopy.