What is the risk of nocturnal supine enteral nutrition?
One complication of enteral nutrition (EN) is gastro-esophageal reflux disease. Semi-recumbent position is advised because posture influence reflux in critically ill patients. No data is available in stable patients.


OBJECTIVE
To study influence of position on reflux during nocturnal nutrition by percutaneous endoscopic gastrostomy in stable patients.


METHODS
Prospective cross-over study. Reflux was measured by 48 h-pH-metry, in supine and semi-recumbent position. The end point was % time spent under pH 4. For analysis, 2 subgroups were identified (refluxers and non-refluxers). A total of 16 patients (65 year+/-13) were included, most had neurological diseases.


RESULTS
There was no increase of reflux probability in any position in all patients (% time spent under pH 4: supine vs. semi-recumbent: 4.4+/-7.7 vs. 3.5+/-7.0 NS). In non-refluxers, supine position did not increase % time under pH 4 (0.1+/-0.12 vs. 0.3+/-0.6, NS), and did not modify other parameters (number of reflux 0 +/-0.9 vs. 7 +/-19 NS, duration of the longest reflux (min) 1.1+/-1.7 vs. 1+/-1.7 NS). In refluxers, supine position did not worsen pre-existent reflux (% time under pH 4: 11.7+/-8.7 vs. 8.9+/-9.7 NS, number of reflux 119+/-88 vs. 91+/-89 NS, duration of the longest reflux (min) 19+/-19 vs. 24+/-21 NS).


CONCLUSIONS
Our data suggest that position does not influence reflux in stable patients with EN.
Castel
Hélène
H
Department of Hepatology and Nutrition Cote de nacre 14033 Caen, Cedex, France.
Tiengou
Laurent-Eric
LE
Besancon
Isabelle
I
Joubert
Corinne
C
Fatome
Armelle
A
Piquet
Marie-Astrid
MA
D000368:Aged; D000369:Aged, 80 and over; D018592:Cross-Over Studies; D004750:Enteral Nutrition / Q000009:adverse effects*; D005764:Gastroesophageal Reflux / Q000209:etiology / Q000517:prevention & control*; D005774:Gastrostomy; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008875:Middle Aged; D008991:Monitoring, Physiologic; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D016683:Supine Position / Q000502:physiology