Document Detail


Does the presence of esophagitis prior to PEG placement increase the risk for aspiration pneumonia?
MedLine Citation:
PMID:  15628706     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The aim of this study is to determine if the endoscopic presence of esophagitis predicts aspiration pneumonia after the initiation of enteral feedings in a newly placed PEG tube. A retrospective analysis of 278 patients who received a PEG tube from November 1999 to June 2002 was performed. All PEG procedures performed by a single endoscopist were reviewed from the GI Trac database at the Medical University of South Carolina. Eleven of the procedures were aborted due to technical difficulties. Nine patients received the PEG for gastric decompression only. Seven patients died within 14 days of PEG placement from non-PEG-related complications and were excluded. The resulting 251 patients included for our analysis successfully had PEG tube placement and had at least 14 days of enteral feeding. Esophagitis was defined macroscopically by the endoscopic presence of mucosal edema, friability, or obscurity of the normal vascular pattern in the distal esophagus. Aspiration was defined as the witnessed regurgitation of or tracheal suctioning of PEG feedings. Pneumonia as a consequence of aspiration was defined by development of fever and new infiltrate on chest radiograph within 14 days of PEG placement. Two hundred fifty-one patients had PEG placement (M, 127; F, 124; average age, 62.4 year; age range, 18-95 years) performed by a single endoscopist over a 32-month period. Fourteen (5.6%) of these patients had clinically evident pulmonary aspiration, with seven of them developing pneumonia. Thirteen (93%) of these patients had normal esophageal mucosa. One of the 24 patients (4%) with esophagitis or esophageal ulceration present endoscopically had an aspiration event with subsequent pneumonia. None of the 20 patients found to have some other form of esophageal pathology had an aspiration event. The overall incidence of aspiration pneumonia after the initiation of PEG feedings was 2.7% (7/251). The odds ratio that the presence of esophagitis would predict the development of aspiration pneumonia was 1.60, with a 95% confidence interval of 0.18 to 13.89. This study argues that the presence of esophagitis alone does not increase the risk of aspiration pneumonia from PEG feedings. Other factors apart from esophagitis play an important role in the incidence of aspiration pneumonia with PEG feeding
Authors:
Matthew L Carnes; David A Sabol; Mark DeLegge
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Digestive diseases and sciences     Volume:  49     ISSN:  0163-2116     ISO Abbreviation:  Dig. Dis. Sci.     Publication Date:    2004 Nov-Dec
Date Detail:
Created Date:  2005-01-04     Completed Date:  2005-01-25     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7902782     Medline TA:  Dig Dis Sci     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1798-802     Citation Subset:  AIM; IM    
Affiliation:
Medical University of South Carolina, Department of Medicine, Division of Gastroenterology and Hepatology, Digestive Disease Center, Charleston, South Carolina 29425, USA.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Ulcer Agents
Enteral Nutrition / adverse effects*,  instrumentation
Esophagitis / complications*
Female
Gastrostomy / adverse effects*,  instrumentation
Humans
Intubation, Gastrointestinal / adverse effects*
Male
Middle Aged
Odds Ratio
Pneumonia, Aspiration / etiology*
Retrospective Studies
Risk Factors
Chemical
Reg. No./Substance:
0/Anti-Ulcer Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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