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World J Gastroenterol. Jan 7, 2006; 12(1): 114-118
Published online Jan 7, 2006. doi: 10.3748/wjg.v12.i1.114
Effect of percutaneous endoscopic gastrostomy on gastro-esophageal reflux in mechanically-ventilated patients
Emmanuel E Douzinas, Andreas Tsapalos, Antonios Dimitrakopoulos, Evanthia Diamanti-Kandarakis, Alexandros D Rapidis, Charis Roussos
Emmanuel E Douzinas, Andreas Tsapalos, Charis Roussos, Department of Critical Care, Evangelismos Hospital, University of Athens, Medical School, Athens 10675, Greece
Antonios Dimitrakopoulos, Eginition Hospital, University of Athens, Medical School, Athens 11528, Greece
Evanthia Diamanti-Kandarakis, 1st Department of Internal Medicine, Laiko Hospital, University of Athens, Medical School, Athens 115 27, Greece
Alexandros D Rapidis, Head and Neck Unit, Greek Anticancer Institute, Athens 11522, Greece
Correspondence to: Emmanuel E Douzinas, Department of Critical Care, Evangelismos Hospital, Athens 10675 Greece. edouzin@cc.uoa.gr
Telephone: +30-210-7243320
Received: May 26, 2005
Revised: June 28, 2005
Accepted: July 27, 2005
Published online: January 7, 2006
Abstract

AIM: To investigate the effect of percutaneous endoscopic gastrostomy (PEG) on gastroesophageal reflux (GER) in mechanically-ventilated patients.

METHODS: In a prospective, randomized, controlled study 36 patients with recurrent or persistent ventilator-associated pneumonia (VAP) and GER > 6% were divided into PEG group (n = 16) or non-PEG group (n  = 20). Another 11 ventilated patients without reflux (GER < 3%) served as control group. Esophageal pH-metry was performed by the “pull through” method at baseline, 2 and 7 d after PEG. Patients were strictly followed up for semi-recumbent position and control of gastric nutrient residue.

RESULTS: A significant decrease of median (range) reflux was observed in PEG group from 7.8 (6.2 - 15.6) at baseline to 2.7 (0 - 10.4) on d 7 post-gastrostomy (P < 0.01), while the reflux increased from 9 (6.2 - 22) to 10.8 (6.3 - 36.6) (P < 0.01) in non-PEG group. A significant correlation between GER (%) and the stay of nasogastric tube was detected (r = 0.56, P < 0.01).

CONCLUSION: Gastrostomy when combined with semi-recumbent position and absence of nutrient gastric residue reduces the gastroesophageal reflux in ventilated patients.

Keywords: Nasogastric tube; Gastroesophageal reflux; Semi-recumbency; Gastric residue; Percutaneous endoscopic gastrostomy.