Brief Article
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World J Gastroenterol. Jan 14, 2011; 17(2): 191-196
Published online Jan 14, 2011. doi: 10.3748/wjg.v17.i2.191
Percutaneous endoscopic gastrostomy and gastro-oesophageal reflux in neurologically impaired children
Mike Thomson, Prithviraj Rao, David Rawat, Tobias G Wenzl
Mike Thomson, Prithviraj Rao, David Rawat, Centre for Paediatric Gastroenterology, Royal Free and University College Medical School, Pond Street, London NW3 2QG, United Kingdom
Mike Thomson, Centre for Paediatric Gastroenterology, Sheffield Childrens NHS Trust, Western Bank, Sheffield, S10 2TH, United Kingdom
Tobias G Wenzl, Kinderklinik, Universitätsklinikum Aachen, Pauwelsst. 30, D 52074, Aachen, Germany
Author contributions: Thomson M, Rawat D and Wenzl TG made the majority of contributions to conception and design and acquisition of data; Rao P was involved in editing the manuscript as well as in analysis and interpretation of data; Thomson M and Rao P drafted the article; all authors revised the manuscript critically for important intellectual content and for the final approval of the version to be published.
Correspondence to: Dr. Mike Thomson, Centre for Paediatric Gastroenterology, Sheffield Childrens NHS Trust, Western Bank, Sheffield, S10 2TH, United Kingdom. mike.thomson@sch.nhs.uk
Telephone: +44-114-2717673 Fax: +44-114-2267956
Received: September 16, 2009
Revised: December 31, 2009
Accepted: January 7, 2010
Published online: January 14, 2011
Abstract

AIM: To investigate the effects of percutaneous endoscopic gastrostomy (PEG) feeding on gastro-oesophageal reflux (GOR) in a group of these children using combined intraluminal pH and multiple intraluminal impedance (pH/MII).

METHODS: Ten neurologically impaired children underwent 12 h combined pH/MII procedures at least 1 d before and at least 12 d after PEG placement.

METHODS: Prior to PEG placement (pre-PEG) a total of 183 GOR episodes were detected, 156 (85.2%) were non-acidic. After PEG placement (post-PEG) a total of 355 episodes were detected, 182 (51.3%) were non-acidic. The total number of distal acid reflux events statistically significantly increased post-PEG placement (pre-PEG total 27, post-PEG total 173, P = 0.028) and the mean distal pH decreased by 1.1 units. The distal reflux index therefore also significantly increased post-PEG [pre-PEG 0.25 (0-2), post-PEG 2.95 (0-40)]. Average proximal pH was lower post-PEG but the within subject difference was not statistically significant (P = 0.058). Median number of non-acid GOR, average reflux height, total acid clearance time and total bolus clearance time were all lower pre-PEG, but not statistically significant.

CONCLUSION: PEG placement increases GOR episodes in neurologically impaired children.

Keywords: Percutaneous endoscopic gastrostomy; Gastro-oesophageal reflux; Multiple intraluminal impedance