title: Elemental diets may reduce the risk of aspiration pneumonia in bedridden gastrostomy-fed patients.
abstract: OBJECTIVE
  Our clinical experience suggested that elemental diets were associated with a reduction in aspiration pneumonia among bedridden patients with percutaneous endoscopic gastrostomy (PEG). We compared the effects of elemental and standard liquid diets on the risk of clinical aspiration pneumonia and gastric emptying in bedridden patients receiving PEG feedings.
  
  
  METHODS
  Study 1: consecutive bedridden PEG patients received elemental diets or standard liquid diets in the same fashion. The frequency of defecation, diet aspirated from the trachea, and aspiration pneumonia during hospitalization were prospectively recorded. Study 2: a randomized, crossover trial using elemental or standard liquid diets containing (13)C sodium acetate as a tracer given to bedridden PEG patients who had experienced aspiration pneumonia. (13)C breath tests were performed to estimate gastric emptying.
  
  
  RESULTS
  Study 1: 127 patients were enrolled, 60 with elemental and 67 with standard liquid diets. The diet was aspirated from the trachea in none (0%) with the elemental diet vs. 8 (11.9%) with standard liquid diets (P=0.0057); aspiration pneumonia developed none with the elemental diet vs. 5 (7.5%) with standard liquid diets (P=0.031) (number needed to treat 14, 95% confidence interval 7-85). Study 2: 19 patients were enrolled. The elemental diet was associated with a significant increase in the 10, 30 or 50% emptying (excretion) time (P<0.001) and increased the area under the curve (% dose/h) compared with the standard liquid diet (P<0.05).
  
  
  CONCLUSIONS
  Elemental diets were associated with more rapid gastric empting and fewer episodes of aspiration than standard liquid diets in bedridden PEG patients. They may be preferred for bedridden PEG patients especially who have experienced aspiration pneumonia. Properly performed randomized-controlled trials are needed to prove this potential benefit.
authors: Digestive Disease Center, Showa Inan General Hospital, Komagane, Japan. horiuchi.akira@sihp.jp
authors: Akira
authors: A
authors: Horiuchi
authors: Yoshiko
authors: Y
authors: Nakayama
authors: Ryosei
authors: R
authors: Sakai
authors: Manabu
authors: M
authors: Suzuki
authors: Masashi
authors: M
authors: Kajiyama
authors: Naoki
authors: N
authors: Tanaka
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001510:Bed Rest; D001944:Breath Tests; D002250:Carbon Radioisotopes; D018592:Cross-Over Studies; D018752:Diet, Fat-Restricted; D004750:Enteral Nutrition / Q000009:adverse effects* / Q000379:methods; D005260:Female; D005526:Food, Formulated; D005746:Gastric Emptying; D005774:Gastrostomy / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007297:Inpatients; D007564:Japan / Q000453:epidemiology; D008297:Male; D011015:Pneumonia, Aspiration / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control*; D011446:Prospective Studies; D012306:Risk; D019346:Sodium Acetate; D016896:Treatment Outcome
chemical_list: D002250:Carbon Radioisotopes; D019346:Sodium Acetate
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