Clinical analysis of gastroesophageal reflux after PEG{A figure is presented}

Background: 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.