Document Detail


Mechanisms of gastroesophageal reflux in critically ill mechanically ventilated patients.
MedLine Citation:
PMID:  15765395     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND & AIMS: Gastroesophageal reflux is a major problem in mechanically ventilated patients and may lead to pulmonary aspiration and erosive esophagitis. Transient lower esophageal sphincter relaxations are the most common mechanism underlying reflux in nonventilated patients. The mechanisms that underlie reflux in critically ill ventilated patients have not been studied. The aim of this study was to determine the mechanisms underlying gastroesophageal reflux in mechanically ventilated patients in the intensive care unit. METHODS: In 15 mechanically ventilated intensive care unit patients, esophageal motility, pH, and intraluminal impedance (11/15 patients) were recorded for 1 hour before and 5 hours during continuous nasogastric feeding. RESULTS: Basal lower esophageal sphincter pressure was uniformly low (2.2 +/- 0.4 mmHg). The median (interquartile range) acid exposure (pH <4) was 39.4% (0%-100%) fasting and 32% (7.5%-94.2%) fed. Acid reflux occurred in 10 patients, but slow drifts in esophageal pH were also an important contributor to acid exposure. If esophageal pH decreased to pH <4, it tended to remain so for prolonged periods. A total of 46 acid reflux events were identified. Most (55%) occurred because of absent lower esophageal sphincter pressure alone; 45% occurred during straining or coughing. CONCLUSIONS: Gastroesophageal reflux in mechanically ventilated patients is predominantly due to very low or absent lower esophageal sphincter pressure, often with a superimposed cough or strain. These data suggest that measures that increase basal LES pressure may be useful to prevent reflux in ventilated patients.
Authors:
Garry Nind; Wei-Hao Chen; Richard Protheroe; Katsuhiko Iwakiri; Robert Fraser; Robert Young; Marianne Chapman; Nam Nguyen; Daniel Sifrim; Rachael Rigda; Richard H Holloway
Related Documents :
669215 - Transmural electrical potential difference in the mammalian esophagus in vivo.
6495875 - Serum gastrin levels and lower oesophageal sphincter pressures in infants with congenit...
3948615 - Hot or cold in anal pain? a study of the changes in internal anal sphincter pressure pr...
1949525 - Effects of thiopentone, propofol, alphaxalone-alphadolone, ketamine and xylazine-ketami...
9039025 - Role of extra- and intracellular ca2+ in the lymphatic myogenic response.
23374895 - Treatment of arterial hypertension in obese patients.
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Gastroenterology     Volume:  128     ISSN:  0016-5085     ISO Abbreviation:  Gastroenterology     Publication Date:  2005 Mar 
Date Detail:
Created Date:  2005-03-14     Completed Date:  2005-04-06     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0374630     Medline TA:  Gastroenterology     Country:  United States    
Other Details:
Languages:  eng     Pagination:  600-6     Citation Subset:  AIM; IM    
Affiliation:
Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
Export Citation:
APA/MLA Format     Download EndNote     Download BibTex
MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Cough / complications,  etiology
Critical Illness / therapy*
Deglutition
Esophagogastric Junction / physiopathology
Female
Gastroesophageal Reflux / etiology*,  physiopathology*
Humans
Male
Middle Aged
Muscle Contraction
Muscle, Smooth / physiopathology
Pressure
Respiration, Artificial / adverse effects*

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


Previous Document:  HNPCC-associated small bowel cancer: clinical and molecular characteristics.
Next Document:  Preterm birth, low birth weight, and risk for esophageal adenocarcinoma.