[Effect of enteral naloxone on the incidence of gastritis and esophagitis in mechanically ventilated patients].
BACKGROUND
Gastrtis and esophagitis are frequent and severe complications in intensive care patients, mainly caused by increased duodenogastral reflux. Opioids, commonly used in intensive care, are known to impair gastrointestinal (GI) motility which increases retrograd flow of gastric content. In a previous study, we showed that enteral administered naloxone reduces gastric reflux by selectively blocking GI opioid receptors. Therefore, in a subpopulation of these patients we studied the effect of enteral naloxone on the incidence of mucosal injury in opioid-treated, mechanically ventilated patients.


METHODS
After IRB approval, mechanically ventilated, fentanyl-treated patients without gastrointestinal surgery or diseases were assigned to receive 8 mg naloxone or placebo four times daily via a gastric tube. Additional inclusion criteria were opioid treatment for at least three days and endoscopy of the upper GI tract. Frequency of gastritis and esophagitis was quantified according to the Savary-Miller Score, and further parameter of GI motility (frequency of propulsive medication, amount of enteral feeding) were measured.


RESULTS
In four of seventeen patients of the naloxone group (24 %) and 14 of 22 patients of the placebo group (64 %; p = 0.02), esophageal or gastral mucosal injuries were detected. In the naloxone group, gastral reflux as well as need for propulsive medication were significantly lower. Volume of enteral feeding showed an increasing trend in the second half of the study.


CONCLUSIONS
Reduction of esophagogastral mucosal injury and reduced need for procinetic medication suggests an improvement of GI motility by enteral naloxone in fentanyl-treated, mechanically ventilated patients.
Meissner
W
W
Klinik für Anästhesiologie und Intensivtherapie, Friedrich-Schiller-Universität Jena. Winfried.Meissner@med.uni-jena.de
Hartmann
M
M
Kähler
G
G
Brauer
M
M
D000328:Adult; D000701:Analgesics, Opioid / Q000009:adverse effects*; D004311:Double-Blind Method; D004941:Esophagitis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D005260:Female; D005283:Fentanyl / Q000009:adverse effects; D005753:Gastric Mucosa / Q000473:pathology; D005756:Gastritis / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D005769:Gastrointestinal Motility / Q000187:drug effects; D006801:Humans; D007441:Intubation, Gastrointestinal; D008297:Male; D008875:Middle Aged; D009270:Naloxone / Q000008:administration & dosage / Q000627:therapeutic use*; D009292:Narcotic Antagonists / Q000008:administration & dosage / Q000627:therapeutic use*; D012121:Respiration, Artificial / Q000009:adverse effects*
D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D005283:Fentanyl