Document Detail

Mechanisms of gastroesophageal reflux in critically ill mechanically ventilated patients.
MedLine Citation:
PMID:  15765395     Owner:  NLM     Status:  MEDLINE    
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.
Garry Nind; Wei-Hao Chen; Richard Protheroe; Katsuhiko Iwakiri; Robert Fraser; Robert Young; Marianne Chapman; Nam Nguyen; Daniel Sifrim; Rachael Rigda; Richard H Holloway
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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    
Department of Gastroenterology, Hepatology and General Medicine, Royal Adelaide Hospital, Adelaide, South Australia, Australia.
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MeSH Terms
Cough / complications,  etiology
Critical Illness / therapy*
Esophagogastric Junction / physiopathology
Gastroesophageal Reflux / etiology*,  physiopathology*
Middle Aged
Muscle Contraction
Muscle, Smooth / physiopathology
Respiration, Artificial / adverse effects*

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