Effect of Percutaneous Endoscopic Gastrostomy on Gastro-esophageal Reflux and Gastric Emptying

Abstract

BACKGROUNDS: Percutaneous endoscopic gastrostomy (PEG) has gained broad acceptance as an effective method for achieving enteral access in patients who need chronic nutritional support. It was reported that gastro-esophageal reflux (GER) was less observed with PEG feeding as compared with naso-gastric tube feeding, and that the posture under feeding may affect GER. However, real change in GER before and after the PEG placement remains unknown. AIMS: We investigated GER using ambulatory pH monitoring, and gastric emptying before and after the PEG. The effect of posture while feeding on the GER was also evaluated. METHODS: Twenty patients (8 men and 12 women; mean age, 79.4 years) who need continuous nutritional support due to various diseases such as a stroke, were registered. Under the written informed consent from patients or their families, ambulatory 24-h esophago-gastric pH monitoring, and the gastric emptying test were performed before (with naso-gastric tube feeding) and 1 month after the PEG placement. Seventy-two hours before the monitoring, drugs which affect gastric acid secretion and/or gastric motility were stopped. The content and pattern of feeding through the tube were fixed. Gastric emptying time was determined by the paracetamol method in which serum acetaminophen level was measured 45 min after drinking the semi-liquid test meal (200 mL, 200 kcal) with acetaminophen (20 mg/kg). Some patients after PEG were fed at Fowler position on the first day and at supine position on the second day with 48-h pH monitoring. RESULTS: The mean of intra-esophageal pH was increased after PEG placement (before: 5.59±0.16, after: 6.05±0.21). The time ratio of intra-esophageal pH less than 4 was significantly decreased (before: 9.5±3.1%, after: 5.8±2.5%), suggesting that GER was less observed with PEG feeding. Gastric acidity evaluated by the mean intra-gastric pH and holding time ratio of intra-gastric pH more than 3, was not varied with PEG placement. Gastric emptying was delayed in patients as compared with those in healthy volunteers, but PEG did not modify gastric emptying. The posture under feeding did not affect GER, gastric acidity, and gastric emptying. CONCLUSIONS: GER was less observed with PEG feeding as compared with naso-gastric tube feeding, suggesting the advantage of PEG feeding in regardless the posture while feeding.