Ono Hiromi, Azuma Takeshi, Miyaji Hideki, Ito Shigeji, Ohtaki Hideho, Ohtani Masahiro, Dojo Manabu, Yamazaki Yukinao, Kuriyama Masaru
Division of Internal Medicine, Ohtaki Hospital, Fukui, Japan.
J Gastroenterol. 2003;38(10):930-6. doi: 10.1007/s00535-003-1174-z.
Percutaneous endoscopic gastrostomy (PEG) is the preferred method for providing enteral nutritional support in patients with dysphagia. We examined gastric antral myoelectrical activity and gastric emptying before and after PEG tube placement to evaluate the effects of PEG on gastric motility.
PEG was performed in 41 patients; 21 fed by total parenteral nutrition (TPN) and 20 who received nasogastric tube feeding (NGF). Antral myoelectrical activity and gastric emptying were examined before and 4 weeks after PEG tube placement.
The percentage of normal-range electrogastrograms (EGGs) was significantly lower in the TPN group than in the NGF group in both the pre- and postprandial periods before PEG tube placement. Enteral feeding after PEG tube placement improved gastric motility in the patients with TPN. The percentage of normal-range EGGs increased significantly after PEG tube placement in both the pre- and postprandial periods, and plasma concentrations of paracetamol increased significantly after PEG tube placement in patients with TPN. A total of 7.3% of the patients developed the complication of gastroesophageal reflux (GER) after PEG tube placement. Gastric myoelectrical activity and gastric emptying were improved in these patients with GER after PEG tube placement. In contrast, the prevalence of esophageal hiatus hernia was significantly higher in patients with GER after PEG tube placement than in patients without GER after PEG tube placement.
Prolonged TPN with bowel rest induces physiological dysfunction of gastric motility. Enteral nutrition is the preferable physiological nutritional route. GER after PEG tube placement is not related to gastric motility. Esophageal hiatus hernia seems to be a major risk factor for GER complications after PEG tube placement. Percutaneous endoscopic gastrostomy (PEG) is the preferred method for providing enteral nutritional support in patients with dysphagia. We examined gastric antral myoelectrical activity and gastric emptying before and after PEG tube placement to evaluate the effects of PEG on gastric motility.
经皮内镜下胃造口术（PEG）是为吞咽困难患者提供肠内营养支持的首选方法。我们在PEG管置入前后检查胃窦肌电活动和胃排空情况，以评估PEG对胃动力的影响。
对41例患者实施PEG；其中21例接受全胃肠外营养（TPN），20例接受鼻胃管喂养（NGF）。在PEG管置入前及置入后4周检查胃窦肌电活动和胃排空情况。
在PEG管置入前的餐前和餐后阶段，TPN组正常范围胃电图（EGG）的百分比均显著低于NGF组。PEG管置入后进行肠内喂养可改善TPN患者的胃动力。PEG管置入后，餐前和餐后阶段正常范围EGG的百分比均显著增加，TPN患者PEG管置入后对乙酰氨基酚的血浆浓度显著增加。共有7.3%的患者在PEG管置入后发生胃食管反流（GER）并发症。PEG管置入后，这些GER患者的胃肌电活动和胃排空得到改善。相比之下，PEG管置入后发生GER的患者食管裂孔疝的患病率显著高于未发生GER的患者。
长期TPN并肠道休息会导致胃动力的生理功能障碍。肠内营养是更可取的生理营养途径。PEG管置入后发生的GER与胃动力无关。食管裂孔疝似乎是PEG管置入后GER并发症的主要危险因素。经皮内镜下胃造口术（PEG）是为吞咽困难患者提供肠内营养支持的首选方法。我们在PEG管置入前后检查胃窦肌电活动和胃排空情况，以评估PEG对胃动力的影响。
