Half-solidification of nutrient does not decrease gastro-esophageal reflux events in patients fed via percutaneous endoscopic gastrostomy

Adachi, Kyoichi; Furuta, K.; Morita, Terumi; Nakata, Shuji; Ohara, Shunji; Tanimura, Takashi; Koshino, Kenji; Miki, Masaharu; Ishimura, Norihisa; Inoue, Yukiko; Ryuko, Kanji; Umegae, Nobuyuki; Ohhata, Syuzo; Katoh, Sadanobu; Yamamoto, Kazuhiko; Nariai, Yukiko; Hashimoto, Yohko; Sumi, Asako; Kawaguchi, Mikiko; Kinoshita, Yoshikazu

doi:10.1016/j.clnu.2009.05.006

Cited by 21 publications

(16 citation statements)

References 10 publications

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“…In PEG patients, the efficacy of semi-solid feed in decreasing or inhibiting GER is not conclusive, with conflicting results being reported 17 18 19. That may be due to differences in the dynamic viscosity of semi-solid feed used in various studies.…”

Section: Discussionmentioning

confidence: 99%

Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG)

2016

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Background and study aims: Feeding-related adverse events after percutaneous endoscopic gastrostomy (PEG) such as aspiration pneumonia may result in prolonged hospitalization and postoperative mortality. This study evaluated the efficacy of using semi-solid feeds to reduce feeding-related adverse events and improve clinical outcomes. Patients and methods: Patients who received PEG for enteral nutrition at our hospital between January 2014 and December 2015 were allocated to a postoperative feeding protocol that used either liquid feed or semi-solid feed. Baseline characteristics, postoperative feeding-related adverse events and clinical outcomes in the 2 groups were prospectively analysed and compared. Results: One hundred and seventeen PEG patients (age range: 59 – 97 years, male: 53) were enrolled with 72 patients given liquid feed and 45 patients receiving semi-solid feed. Baseline characteristics were similar in both groups. The semi-solid feed group experienced fewer incidence of feeding-related aspiration pneumonia (2.2 % vs. 22.2 %, P < 0.005) and shorter postoperative hospital length of stay (12.7 days vs. 18.8 days, P < 0.01). Significant differences were not observed in the frequency of peristomal infection (11.1 % vs. 12.5 %, P = 0.82), feeding-related diarrhea (2.2 % vs. 12.5 %, P = 0.09) and 30-day mortality rates (2.2 % vs. 8.3 %, P = 0.25). Conclusions: Semi-solid feeding may reduce the risk of aspiration pneumonia and shorten postoperative hospital length of stay after PEG. Semi-solid feeds are safe to use and can be employed either as a first line feeding protocol or an alternative when liquid feeding is unsuccessful.

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Section: Discussionmentioning

confidence: 99%

Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG)

2016

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“…Recently, we demonstrated that half-solidification of nutrients could not decrease the number of GER events and half-solidification tends to increase acidic GER in patients with PEG feeding using the esophageal MII-pH monitoring method. (10) However, the results of this prospective multi-centre study showed that the usage of half-solid nutrients significantly decreases the percentage of days with fever in elderly patients with PEG feeding. Since fever in patients with PEG feeding is mainly caused by aspiration of refluxed gastric contents, the result of this study seems not to fit with the results of our previous MII-pH monitoring study, which could not demonstrate the reduction of GER events during half-solid nutrient feeding.…”

Section: Discussionmentioning

confidence: 82%

“…(10) However, the volume of GER of gastric contents, which the MII-pH monitoring system couldn’t measure, is considered to affect the occurrence of aspiration pneumonitis. We, therefore, performed this prospective multi-centre study to test the efficacy of half-solidification of nutrients for preventing aspiration pneumonitis in elderly patients with tube feeding via PEG.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of half-solid nutrient for the elderly patients with percutaneous endoscopic gastrostomy

Shizuku¹,

Adachi

Furuta

et al. 2011

J. Clin. Biochem. Nutr.

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Percutaneous endoscopic gastrostomy tube feeding is widely used for patients with swallowing dysfunction and a history of repeated aspiration pneumonitis. However, liquid nutrient feeding via percutaneous endoscopic gastrostomy is not effective enough to prevent aspiration pneumonitis and related inflammatory responses. We performed this prospective multi-centre study to clarify the efficacy of half-solidification of nutrients to prevent fever possibly caused by aspiration pneumonitis in elderly patients with percutaneous endoscopic gastrostomy. The study subjects were 42 elderly patients undergoing percutaneous endoscopic gastrostomy feeding (mean age 85.8 years). All subjects were fed half-solid as well as liquid nutrients for 8 weeks respectively in a cross over design. We counted the number of days with fever caused by pneumonitis and unidentified origin. Thirty-two of 42 patients were successfully observed in both nutrient periods. Fever was frequently observed in both nutrient periods, however, the percentage of observational days with fever during half-solid nutrient feeding was significantly lower than that during liquid nutrient feeding (15.3 ± 0.3 vs 19.8 ± 0.4%, p = 0.030). The percentage of observational days when patients had diarrhea was not significantly different (10.1 ± 3.8 vs 7.2 ± 3.2%, p = 0.357). In conclusion, half-solid nutrient feeding was determined to be effective for reducing fever in patients with percutaneous endoscopic gastrostomy feeding.

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“…Indeed, we have previously demonstrated that the number of acid reflux events after half-solid nutrient feeding tended to be higher than that after liquid nutrient feeding. (21) In contrast to the delivery of half-solid nutrient with high viscosity, pectin solution can be easily infused into the stomach via the PEG tube and increase the viscosity of intragastric liquid nutrient. It is also considered to reduce the width of the acid pocket, since the solution can also easily mix with the gastric acidic liquid contents.…”

Section: Discussionmentioning

confidence: 99%

Efficacy of pectin solution for preventing gastro-esophageal reflux events in patients with percutaneous endoscopic gastrostomy

Adachi¹,

Furuta²,

Aimi³

et al. 2012

J. Clin. Biochem. Nutr.

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The aim of this study was to determine the efficacy of pectin solution, which increases the viscosity of liquid nutrient, for prevention of gastro-esophageal reflux in comparison with half-solid nutrient. The subjects were 10 elderly patients undergoing percutaneous endoscopic gastrostomy feeding. Twenty-four-hour esophageal multichannel intraluminal impedance and pH testing was performed during intake of half-solid nutrient and a combination of pectin solution and liquid nutrient. During 4 h after delivery, there was no significant difference in the total number of gastro-esophageal reflux events between the feeding of the half-solid nutrient and the combination of pectin solution and liquid nutrient (5.7 ± 1.2 vs 5.3 ± 1.0/4 h). Acidic reflux after delivery of the half-solid nutrient was significantly more frequent than that after delivery of the combination of pectin solution and liquid nutrient (80.7% vs 60.4%, p = 0.018). The incidence of gastro-esophageal reflux reaching the upper portion of the esophagus tended to be higher during delivery of the half-solid nutrient than during delivery of the combination of pectin solution and liquid nutrient (47.4% vs 34.0%, p = 0.153). In conclusion, the usage of pectin solution combined with liquid nutrient is effective for preventing acidic gastro-esophageal reflux and gastro-esophageal reflux reaching the upper portion of the esophagus.

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Half-solidification of nutrient does not decrease gastro-esophageal reflux events in patients fed via percutaneous endoscopic gastrostomy

Cited by 21 publications

References 10 publications

Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG)

Semi-solid feeds may reduce the risk of aspiration pneumonia and shorten postoperative length of stay after percutaneous endoscopic gastrostomy (PEG)

Efficacy of half-solid nutrient for the elderly patients with percutaneous endoscopic gastrostomy

Efficacy of pectin solution for preventing gastro-esophageal reflux events in patients with percutaneous endoscopic gastrostomy

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