The effects of bolus and continuous nasogastric feeding on gastro-oesophageal reflux and gastric emptying in healthy volunteers: a randomised three-way crossover pilot study.
OBJECTIVE
Nasogastric feeding may result in gastro-oesophageal reflux and, therefore, increase the risk of aspiration. This may be greater when feeds are administered via a bolus than by infusion. We aimed to measure gastric emptying time and quantify gastro-oesophageal reflux in healthy volunteers given a liquid feed via an oral bolus (OB), a nasogastric tube bolus (TB) and a nasogastric tube drip (TD).


METHODS
Twelve male volunteers participated in three separate studies (OB, TB and TD) in random order, each 3 days apart. The feed consisted of 220 ml Ensure Plus (1.5 kcal/ml), labelled with 12 MBq (99m)Tc DTPA. The OB and TB were given over 5 min and the infusion rate for the TD was 55 ml/h. Gastric emptying time was measured using gamma scintigraphy. Gastro-oesophageal reflux was observed continuously until the stomach was empty, using a multichannel intraluminal impedance catheter.


RESULTS
Mean (95% CI) T(50) gastric emptying times for the OB and TB studies were 41.3 (36.5-46.2) min and 36.2 (30.6-41.8) min respectively (p=0.19). The stomach emptied at a rate equal to the infusion rate in the TD studies. Median (IQR) number of reflux episodes for the OB, TB and TD studies were 4.5 (2.0-6.0), 3.0 (2.0-4.75) and 2.0 (0.25-6.25) respectively. Median (IQR) total duration of reflux for the OB, TB and TD studies were 38 (20-242), 49 (17-71) and 36 (1-125) s respectively (p=NS).


CONCLUSIONS
The lack of difference in gastro-oesophageal reflux between bolus and continuous feeding indicates that in healthy volunteers both methods are equally safe with respect to the risk of aspiration.
Department of Gastroenterology, Wolfson Digestive Diseases Centre, Nottingham University Hospitals, Queen's Medical Centre, Nottingham, NG7 2UH, UK. tim.bowling@nuh.nhs.uk
Tim E
TE
Bowling
Brett
B
Cliff
Jeff W
JW
Wright
P Elaine
PE
Blackshaw
Alan C
AC
Perkins
Dileep N
DN
Lobo
D000328:Adult; D019540:Area Under Curve; D018592:Cross-Over Studies; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D005746:Gastric Emptying / Q000187:drug effects* / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007263:Infusions, Parenteral / Q000009:adverse effects / Q000379:methods; D007275:Injections, Intravenous / Q000009:adverse effects / Q000379:methods; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D010865:Pilot Projects; D053120:Respiratory Aspiration / Q000517:prevention & control; D012307:Risk Factors; D013997:Time Factors