Comparison of tolerance and change of intragastric pH between early nasogastric and nasojejunal feeding following resection of colorectal cancer.
BACKGROUND
Early feeding after injury has been suggested to decrease morbidity and mortality in many studies. Intrajejunal feeding has been preferred over intragastric feeding due to earlier return of peristalsis following laparotomy. Few reports, however, have focused on the tolerance and change in pH inside the stomach after intragastric and intrajejunal feeding. The aim of the present study was the assessment of (1) the postoperative tolerance of intragastric and intrajejunal feeding, and (2) the effect of intragastric and intrajejunal feeding on intragastric pH value.


METHODS
From April 1998 to October 2002, 140 patients underwent colon resection for colorectal cancer entered the study. The patients were divided into seven groups of 20 patients each. Group I was kept on NPO for 1 week. Groups II, III, and IV were fed through a nasogastric (NG) tube from the second to the sixth postoperative day (POD) with low residual (Osmolite-HN), high-fat (Pulmocare), and glutamine-containing (AlitraQ) enteral formulas, respectively. Groups V, VI, and VII were fed through a nasojejunal (NJ) tube from the second to the sixth POD with Osmolite-HN, Pulmocare, and AlitraQ, respectively. Feeding started at 500 kcal/500 cm(3)/d. If the patient tolerated the formula well, feeding increased to 1,500 kcal/1,500 cm(3)/d the following day. Intragastric pH was measured preoperatively and then twice daily until the sixth POD.


RESULTS
Poor tolerance occurred in 14 patients (23%) with NG tube feeding and 18 patients (30%) with NJ tube feeding. The pH value of intragastric juice increased significantly once NG feeding started (3.67+/-1.33 on the third POD; 4.28+/-1.26 on the sixth POD). However, the pH value remained low after NJ feeding was started (2.09+/-1.46 on the third POD; 2.14+/-1.49 on the sixth POD).


CONCLUSIONS
This series suggests that (1) the majority of patients can tolerate early feeding well following resection of colorectal cancer, and NJ feeding is not necessarily better tolerated than NG feeding; (2) early NG, but not the NJ feeding, can significantly elevate the intragastric pH value in patients who underwent resection of colorectal cancer. NG may be more effective than NJ feeding in preventing stress-induced gastropathy by elevating the pH value of intragastric juice.
Hsu
Tzu-Chi
TC
Nutrition Support Service, Mackay Memorial Hospital, Department of Surgery, Taipei Medical University, #92, Section 2, Chung-San North Road, Taipei, Taiwan. tzuchi@ms2.mmh.org.tw
Su
Chiu-Feng
CF
Huang
Pi-Chen
PC
Lu
Shu-Ching
SC
Tsai
Shu-Ling
SL
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000601:surgery / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D005526:Food, Formulated; D005750:Gastric Juice / Q000737:chemistry*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007441:Intubation, Gastrointestinal / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011182:Postoperative Care; D016896:Treatment Outcome