3rd Department of Critical Care, Evgenidion Hospital, University of Athens Medical School, Athens 115 28, Greece.
World J Gastroenterol. 2009 Nov 21;15(43):5455-60. doi: 10.3748/wjg.15.5455.
To investigate factors predicting failure of percutaneous endoscopic gastrostomy (PEG) to eliminate gastroesophageal reflux (GER).
Twenty-nine consecutive mechanically ventilated patients were investigated. Patients were evaluated for GER by pH-metry pre-PEG and on the 7th post-PEG day. Endoscopic and histologic evidence of reflux esophagitis was also carried out. A beneficial response to PEG was considered when pH-metry on the 7th post-PEG day showed that GER was below 4%.
Seventeen patients responded (RESP group) and 12 did not respond (N-RESP) to PEG. The mean age, sex, weight and APACHE II score were similar in both groups. GER (%) values were similar in both groups at baseline, but were significantly reduced in the RESP group compared with the N-RESP group on the 7th post-PEG day [2.5 (0.6-3.8) vs 8.1 (7.4-9.2, P < 0.001)]. Reflux esophagitis and the gastroesophageal flap valve (GEFV) grading differed significantly between the two groups (P = 0.031 and P = 0.020, respectively). Histology revealed no significant differences between the two groups.
Endoscopic grading of GEFV and the presence of severe reflux esophagitis are predisposing factors for failure of PEG to reduce GER in mechanically ventilated patients.
探讨预测经皮内镜胃造口术（PEG）消除胃食管反流（GER）失败的因素。
连续调查了 29 例机械通气患者。在 PEG 前和 PEG 后第 7 天，通过 pH 监测评估患者的 GER。还进行了内镜和反流性食管炎的组织学证据检查。当第 7 天的 pH 监测显示 GER 低于 4%时，认为 PEG 有良好的反应。
17 例患者有反应（RESP 组），12 例患者无反应（N-RESP 组）。两组的平均年龄、性别、体重和急性生理学和慢性健康评估 II 评分（APACHE II 评分）相似。两组在基线时的 GER（%）值相似，但在第 7 天的 RESP 组明显低于 N-RESP 组[2.5（0.6-3.8）比 8.1（7.4-9.2，P < 0.001）]。反流性食管炎和胃食管瓣（GEFV）分级在两组之间差异有统计学意义（P = 0.031 和 P = 0.020）。组织学检查显示两组之间无显著差异。
GEFV 的内镜分级和严重反流性食管炎的存在是机械通气患者 PEG 不能降低 GER 的预测因素。
