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Journal of Parenteral and Enteral Nutrition
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Original Communications

Inhibition of Gastroesophageal Reflux by Semi-solid Nutrients in Patients With Percutaneous Endoscopic Gastrostomy

Shinji Nishiwaki, MD, PhD1, Hiroshi Araki, MD, PhD2, Yohei Shirakami, MD2, Junji Kawaguchi, MD1, Naofumi Kawade, MD1, Masahide Iwashita, MD1, Atsushi Tagami, MD, PhD1, Hiroo Hatakeyama, MD, PhD1, Takao Hayashi, MD, PhD1, Teruo Maeda, MD, PhD1 and Koushirou Saitoh, MD, PhD1

From the 1 Department of Internal Medicine, Nishimino Kosei Hospital, and 2 Department of Gastroenterology, Graduate School of Medicine, Gifu University, Gifu, Japan.

Address correspondence to: Shinji Nishiwaki, MD, PhD, Department of Internal Medicine, Nishimino Kosei Hospital, Oshikoshi 986, Yoro-cho, Yoro-gun, Gifu 503-1394, Japan; e-mail: wakky{at}nishimino.gfkosei.or.jp.

Background: Aspiration is one of the major complications after percutaneous endoscopic gastrostomy (PEG). The administration of semi-solid nutrients by means of gastrostomy tube has recently been reported to be effective in preventing aspiration pneumonia. The effects of semi-solid nutrients on gastroesophageal reflux, intragastric distribution, and gastric emptying were evaluated. Methods: Semi-solid nutrients were prepared by liquid nutrients mixed with agar at the concentration of 0.5%. The distribution of the administered radiolabeled liquid and semi-solid nutrients was monitored by a scintillation camera for 15 post-PEG patients. The percentage of esophageal reflux, the distribution of the proximal and distal stomach, and the gastric emptying time were evaluated. Results: The percentage of gastroesophageal reflux was significantly decreased in semi-solid nutrients (0.82 ± 1.27%) compared with liquid nutrients (3.75 ± 4.25%), whereas the gastric emptying time was not different. The distribution of semi-solid nutrients was not different from liquid nutrients in the early phase, whereas higher retention of liquid nutrients in the proximal stomach was observed in the late phase. Conclusions: Gastroesophageal reflux was significantly inhibited by semi-solid nutrients. One of the mechanisms of the inhibition is considered to be an improvement in the transition from the proximal to distal stomach in semi-solid nutrients.

Key Words: percutaneous endoscopic gastrostomy • gastroesophageal reflux • semi-solid nutrients • gastric emptying • intragastric distribution

This version was published on September 1, 2009

Journal of Parenteral and Enteral Nutrition, Vol. 33, No. 5, 513-519 (2009)
DOI: 10.1177/0148607108327045
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