[Dysphagia] Elders and PEG

[eripley at yahoo.com (Irene Campbell-Taylor)]

  Clinical analysis of gastroesophageal reflux after PEG
   Gastrointestinal Endoscopy 
Volume 64, Issue 6 , December 2006, Pages 890-896
  Shinji Nishiwaki MD , a, Hiroshi Araki MDa, Naoe Goto MDa, Yukari Niwa MDa, Masaya Kubota MDa, Masahide Iwashita MDa, Nobuhito Onogi MDa, Hiroo Hatakeyama MDa, Takao Hayashi MDa, Teruo Maeda MDa and Koushirou Saitoh MDa 
  
It is difficult to predict whether or not gastroesophageal reflux (GER), such as aspiration or vomiting, will occur after PEG. 
  Objective
  To identify factors that would support the prediction of aspiration after PEG. 
  Design
  Case-control study. 
  Setting
  Patients who underwent PEG from February 1998 to June 2005 in our hospital. 
  Patients
  The study included 178 patients. 
  Interventions
  Endoscopic observation was carried out during PEG tube placement and at PEG tube replacement to determine the presence of hiatus hernia and/or reflux esophagitis. 
  Main Outcome Measurements
  Gastric emptying and GER index (GERI) were measured by using a radioisotope technique. 
  Results
  The patients were divided into 2 groups: the non-GER (NGER) group (n = 108), who had no symptoms of GER, and the GER group (n = 70), who showed these symptoms. No significant differences were observed between the groups in age, sex, morbidity, the presence of reflux esophagitis at PEG tube placement, gastric emptying, or serum albumin levels. The presence of a hiatus hernia (P = .028) and reflux esophagitis grading Los Angeles classification C or D (P = .008) were significantly more frequent in the GER group compared with the NGER group. The GERI was also significantly higher in the GER group than in the NGER group (P < .0001). 
  Conclusions
  The presence of hiatus hernia, severe reflux esophagitis, and a high GERI might be predictive factors of aspiration or vomiting after PEG tube placement.
   


Dr I Campbell-Taylor
Clinical Neuroscientist
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