Original Article EjtJ01KOhcfoC980yrbeu18.iBfon3grS20ntN1i-oni1a605,cal-4c0iJ5lo/e08a8jAftcap96ybCratfnilocci.1nrl e1iFyc-ra5el8eBRoioacdhficeaml piRstersyeeanrccdhtNJuaiptrnaitnionsolution for preventing gastro-esophageal reflux events in patients with percutaneous endoscopic gastrostomy Kyoichi Adachi,1,* Kenji Furuta,2 Masahito Aimi,2 Kousuke Fukazawa,2 Shino Shimura,2 Shunji Ohara,2 Shuji Nakata,2 Yukiko Inoue,3 Kanji Ryuko,3 Junichi Ishine,3 Kyoko Katoh,3 Toshiaki Hirata,3 Shuzo Ohhata,3 Setsushi Katoh,3 Mika Moriyama,1 Masuko Sumikawa,1 Mari Sanpei1 and Yoshikazu Kinoshita2 1Department of Clinical Nursing and 2Second Department of Internal Medicine, Shimane University Faculty of Medicine, 89-1 Enya-cho, Izumo-shi, Shimane 693-8501, Japan 3Katoh Hospital, 383-1 Kawamoto, Kawamoto-cho, Shimane 696-0001, Japan (Re?ce?ived 11 May, 2011; Accepted 24 June, 2011) svCTthirde2TCeieca0hodtta0eipisvdt?myheireusigosoaCehfnro,tigtmod©hipinimsse2atnorl0sinw0tbaus?ucodctJriAyekoCsntsBwit,sraNiaapbrsntruiodcttipoloernerddplyeirLstotceirdciritumebecnuditsnt.ieoed,ntuwhinehdiaecenrhfyftihcpmeaecteryemdrimoiutfsmspo,uefpnctrthoeine- solution, which increases the viscosity of liquid nutrient, for prevention of gastro-esophageal reflux in comparison with half- solid nutrient. The subjects were 10 elderly patients undergoing percutaneous endoscopic gastrostomy feeding. Twenty-four-hour esophageal multichannel intraluminal impedance and pH testing was performed during intake of half-solid nutrient and a combi- nation of pectin solution and liquid nutrient. During 4 h after delivery, there was no significant difference in the total number of gastro-esophageal reflux events between the feeding of the half-solid nutrient and the combination of pectin solution and liquid nutrient (5.7 ± 1.2 vs 5.3 ± 1.0/4 h). Acidic reflux after delivery of the half-solid nutrient was significantly more frequent than that after delivery of the combination of pectin solution and liquid nutrient (80.7% vs 60.4%, p = 0.018). The incidence of gastro- esophageal reflux reaching the upper portion of the esophagus tended to be higher during delivery of the half-solid nutrient than during delivery of the combination of pectin solution and liquid nutrient (47.4% vs 34.0%, p = 0.153). In conclusion, the usage of pectin solution combined with liquid nutrient is effective for pre- venting acidic gastro-esophageal reflux and gastro-esophageal reflux reaching the upper portion of the esophagus. Key Words: percutaneous endoscopic gastrostomy, half-solidification, aspiration pneumonitis, pH monitoring, impedance P widely used for patients with swallowing dysfunction caused PIenrcturotadnueoctuisoenndoscopic gastrostomy (PEG) tube feeding is by a number of disease conditions or a history of repeated aspiration pneumonitis. Aspiration pneumonitis caused by reflux of gastric contents including nutrients supplied via PEG is one of the most frequent and life-threatening events during long-term PEG feeding.(1–4) Solidification of nutrients is considered to be an effective method for preventing gastro-esophageal reflux (GER) of such nutrients, and several studies have demonstrated that increasing their viscosity reduces the risk of GER in infants, based mainly on the number and frequency of regurgitation and vomiting.(5–7) Kanie and coworkers(8) previously demonstrated that half-solidification of nutrient was useful for decreasing GER in patients receiving PEG nutrition. Therefore, half-solidification of nutrients has been widely used to prevent aspiration pneumonitis in patients undergoing PEG feeding in Japan, although the efficacy of this approach has not been fully determined. We recently dem- onstrated that the use of half-solid nutrients reduces the proportion doi: 10.3164/jcbn.11-58 ©2012 JCBN of observational days when patients have fever in comparison with the use of liquid nutrients.(9) The use of highly thickened nutrient via PEG might effectively prevent GER of the nutrient itself. However, the most effective method for half-solidification of nutrient and the optimal viscosity of half-solid nutrient for preventing GER events, including GER of gastric acid, have not been fully investigated. Pectin solution is reported to increase the viscosity of liquid nutrient even when it is infused separately into the stomach when liquid nutrient is being supplied.(10–12) The combined usage of pectin solution with liquid nutrient has been reported to prevent GER of liquid nutrient and diarrhea induced by rapid infusion of nutrients in patients undergoing PEG feeding.(10,11) However, the efficacy of pectin solution for prevention of GER has not yet been investigated in comparison with the usage of half-solid nutrient with high viscosity. Combined multichannel intraluminal impedance (MII) and pH (MII-pH) testing is the best clinically available tool for monitoring of GER.(13,14) MII monitoring can detect reflux episodes indepen- dent of their pH by measuring the resistance of the intraluminal content to alternating current (i.e., impedance). This makes it possible to characterize the physical composition of the refluxate (i.e., liquid, gas, or mixed) and, when combined with pH moni- toring, to separate acid from non-acid reflux episodes based on predefined pH criteria.(13,14) Thus, all types of reflux episodes can be evaluated by the MII-pH monitoring system. The aim of this study was to clarify the efficacy of combined usage of pectin solution with liquid nutrient for preventing GER events in patients receiving PEG nutrition in comparison with the use of half-solid nutrient with high viscosity. Subjects and Methods The subjects were 10 elderly patients undergoing PEG feeding (7 females; overall mean age 82.0 years) at Katoh Hospital, Shimane, Japan. PEG feeding had been started because of swallowing dysfunction resulting from cerebral infarction or cerebral bleeding, and the duration of PEG feeding had exceeded one year in all cases. None of the subjects had a history of upper gastrointestinal surgery, or were taking regular medications known to influence upper gastro-intestinal motor function. Four of 10 study subjects were taking anti-secretory drugs, such as proton pump *To whom correspondence should be addressed. E-mail: kadachi@med.shimane-u.ac.jp J. Clin. Biochem. Nutr. | May 2012 | vol. 50 | no. 3 | 190–194