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Why does percutaneous endoscopic gastrostomy fail to eliminate gastrooesophageal reflux?
Gastrooesophageal reflux (GER) is a common problem in mechanically ventilated patients and contributes to the development of oesophageal mucosal injury and even erosive oesophagitis. The relationship between percutaneous endoscopic gastrostomy (PEG) and subsequent development of GER is complex and not well understood.
A research article be published on 21 November in the World Journal of Gastroenterology addresses this question. The research team from Greece explored the factors that interfere with failure of PEG to reduce GER in critically ill, mechanically ventilated patients.
A cohort of 29 consecutive mechanically ventilated patients undergoing PEG was prospectively evaluated. The patients were divided into 2 groups based on whether GER decreased to less than 4% (responders, RESP group) or remained unchanged or worsened (non-responders, N-RESP group) after PEG placement. Reflux oesophagitis and the gastrooesophageal flap valve (GEFV) grading differed significantly between the two groups.
The researchers drew a conclusion that gastrooesophageal reflux is not a contraindication for PEG tube placement. By identifying the factors that predict failure of PEG to decrease GER, their study may represent a reference in deciding which patients are likely to benefit from PEG tube placement and thus protect them from the development of oesophagitis and even ventilator-associated pneumonia.
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