Effects of percutaneous endoscopic gastrostomy tube placement on gastric antral motility and gastric emptying.
BACKGROUND
Percutaneous endoscopic gastrostomy (PEG) is the preferred method for providing enteral nutritional support in patients with dysphagia. We examined gastric antral myoelectrical activity and gastric emptying before and after PEG tube placement to evaluate the effects of PEG on gastric motility.


METHODS
PEG was performed in 41 patients; 21 fed by total parenteral nutrition (TPN) and 20 who received nasogastric tube feeding (NGF). Antral myoelectrical activity and gastric emptying were examined before and 4 weeks after PEG tube placement.


RESULTS
The percentage of normal-range electrogastrograms (EGGs) was significantly lower in the TPN group than in the NGF group in both the pre- and postprandial periods before PEG tube placement. Enteral feeding after PEG tube placement improved gastric motility in the patients with TPN. The percentage of normal-range EGGs increased significantly after PEG tube placement in both the pre- and postprandial periods, and plasma concentrations of paracetamol increased significantly after PEG tube placement in patients with TPN. A total of 7.3% of the patients developed the complication of gastroesophageal reflux (GER) after PEG tube placement. Gastric myoelectrical activity and gastric emptying were improved in these patients with GER after PEG tube placement. In contrast, the prevalence of esophageal hiatus hernia was significantly higher in patients with GER after PEG tube placement than in patients without GER after PEG tube placement.


CONCLUSIONS
Prolonged TPN with bowel rest induces physiological dysfunction of gastric motility. Enteral nutrition is the preferable physiological nutritional route. GER after PEG tube placement is not related to gastric motility. Esophageal hiatus hernia seems to be a major risk factor for GER complications after PEG tube placement. Percutaneous endoscopic gastrostomy (PEG) is the preferred method for providing enteral nutritional support in patients with dysphagia. We examined gastric antral myoelectrical activity and gastric emptying before and after PEG tube placement to evaluate the effects of PEG on gastric motility.
Ono
Hiromi
H
Division of Internal Medicine, Ohtaki Hospital, Fukui, Japan.
Azuma
Takeshi
T
Miyaji
Hideki
H
Ito
Shigeji
S
Ohtaki
Hideho
H
Ohtani
Masahiro
M
Dojo
Manabu
M
Yamazaki
Yukinao
Y
Kuriyama
Masaru
M
D000082:Acetaminophen / Q000097:blood; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018712:Analgesics, Non-Narcotic / Q000097:blood; D003680:Deglutition Disorders / Q000097:blood / Q000503:physiopathology / Q000628:therapy; D016145:Endoscopy, Digestive System; D004750:Enteral Nutrition / Q000009:adverse effects; D005260:Female; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D005769:Gastrointestinal Motility / Q000502:physiology*; D005774:Gastrostomy; D006551:Hernia, Hiatal / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010289:Parenteral Nutrition, Total; D011183:Postoperative Complications / Q000097:blood / Q000209:etiology / Q000503:physiopathology; D019518:Postprandial Period / Q000502:physiology; D015995:Prevalence; D016896:Treatment Outcome
D018712:Analgesics, Non-Narcotic; D000082:Acetaminophen