Reasons of PEG failure to eliminate gastroesophageal reflux in mechanically ventilated patients.
OBJECTIVE
To investigate factors predicting failure of percutaneous endoscopic gastrostomy (PEG) to eliminate gastroesophageal reflux (GER).


METHODS
Twenty-nine consecutive mechanically ventilated patients were investigated. Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day. Endoscopic and histologic evidence of reflux esophagitis was also carried out. A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%.


RESULTS
Seventeen patients responded (RESP group) and 12 did not respond (N-RESP) to PEG. The mean age, sex, weight and APACHE II score were similar in both groups. GER (%) values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 (0.6-3.8) vs 8.1 (7.4-9.2, P < 0.001)]. Reflux esophagitis and the gastroesophageal flap valve (GEFV) grading differed significantly between the two groups (P = 0.031 and P = 0.020, respectively). Histology revealed no significant differences between the two groups.


CONCLUSIONS
Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.
Douzinas
Emmanuel E
EE
3rd Department of Critical Care, Evgenidion Hospital, University of Athens Medical School, Athens 115 28, Greece. edouzin@med.uoa.gr
Andrianakis
Ilias
I
Livaditi
Olga
O
Bakos
Dimitrios
D
Flevari
Katerina
K
Goutas
Nikos
N
Vlachodimitropoulos
Dimitrios
D
Tasoulis
Marios-Konstantinos
MK
Betrosian
Alex P
AP
D000328:Adult; D000368:Aged; D004724:Endoscopy / Q000379:methods; D004750:Enteral Nutrition / Q000379:methods; D004942:Esophagitis, Peptic / Q000628:therapy; D004945:Esophagoscopy / Q000379:methods; D005260:Female; D005764:Gastroesophageal Reflux / Q000628:therapy*; D005773:Gastroscopy / Q000379:methods; D005774:Gastrostomy / Q000379:methods*; D006801:Humans; D006863:Hydrogen-Ion Concentration; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial / Q000009:adverse effects* / Q000379:methods; D016896:Treatment Outcome