Reasons of PEG failure to eliminate gastroesophageal refluxin mechanically ventilated patients

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.

Nasogastric Tube Feeding-Induced Esophageal Bezoar: Case Description

“…In return, gastroesophageal reflux can be exacerbated by supine positioning of the patient [ 13 ], as it will induce relaxation of the lower esophageal sphincter. Wang et al [ 14 ] demonstrated that 40% of patients with type II diabetes mellitus showed symptoms of reflux, as well.…”

Influence of replacing percutaneous endoscopic gastrostomy for nasogastric tube feeding on gastroesophageal reflux disease with erosive esophagitis

“…Percutaneous endoscopic gastrostomy is generally regarded as safer than the traditional surgical gastrostomy. However, several complications have been documented such as peristomal wound infection, pneumonia, gastroesophageal reflux disease (GERD), buried bumper syndrome, gastroparesis and bleeding [2–4].…”

“…Endoscopy has excellent specificity for diagnosing GERD, especially when patients have GERD with erosive esophagitis (EE) [5]. In previous studies, patients have not received the same pre‐ and post‐PEG endoscopic assessment for GERD [4,8]. In addition, most studies only evaluate the incidence of gastroesophageal reflux episodes after PEG [10–12].…”