Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Nov 21, 2009; 15(43): 5455-5460
Published online Nov 21, 2009. doi: 10.3748/wjg.15.5455
Reasons of PEG failure to eliminate gastroesophageal reflux in mechanically ventilated patients
Emmanuel E Douzinas, Ilias Andrianakis, Olga Livaditi, Dimitrios Bakos, Katerina Flevari, Nikos Goutas, Dimitrios Vlachodimitropoulos, Marios-Konstantinos Tasoulis, Alex P Betrosian
Emmanuel E Douzinas, Ilias Andrianakis, Olga Livaditi, Dimitrios Bakos, Katerina Flevari, Marios-Konstantinos Tasoulis, Alex P Betrosian, 3rd Department of Critical Care, Evgenidion Hospital, University of Athens Medical School, Athens 115 28, Greece
Nikos Goutas, Dimitrios Vlachodimitropoulos, The Laboratory of Pathology, Evgenidion Hospital, University of Athens Medical School, Athens 115 28, Greece
Author contributions: Douzinas EE, Andrianakis I, Betrosian AP, contributed equally to this work; Douzinas EE, Andrianakis I, Bakos D, Flevari K, performed the research; Livaditi O, Tasoulis MK, analyzed the data; Goutas N, Vlachodimitropoulos D performed the histology; Douzinas EE, Betrosian AP wrote the paper.
Correspondence to: Emmanuel E Douzinas, MD, 3rd Department of Critical Care, Evgenidion Hospital, 20 Papadiamantopoulou St., Athens 115 28, Greece. edouzin@med.uoa.gr
Telephone: +30-210-7208295 Fax: +30-210-7220540
Received: August 27, 2009
Revised: October 12, 2009
Accepted: October 19, 2009
Published online: November 21, 2009
Abstract

AIM: To investigate factors predicting failure of percutaneous endoscopic gastrostomy (PEG) to eliminate gastroesophageal reflux (GER).

METHODS: Twenty-nine consecutive mechanically ventilated patients were investigated. Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day. Endoscopic and histologic evidence of reflux esophagitis was also carried out. A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%.

RESULTS: Seventeen patients responded (RESP group) and 12 did not respond (N-RESP) to PEG. The mean age, sex, weight and APACHE II score were similar in both groups. GER (%) values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 (0.6-3.8) vs 8.1 (7.4-9.2, P < 0.001)]. Reflux esophagitis and the gastroesophageal flap valve (GEFV) grading differed significantly between the two groups (P = 0.031 and P = 0.020, respectively). Histology revealed no significant differences between the two groups.

CONCLUSION: Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.

Keywords: Esophagitis; Gastroesophageal reflux; Percutaneous endoscopic gastrostomy