Percutaneous endoscopic gastrostomy--its application in patients with neurological disease

Improvement in nutritional status and quality of life in patients after percutaneous endoscopic gastrostomy

AIM: To evaluate the nutritional status and quality of life in patients after percutaneous endoscopic gastrostomy (PEG).

METHODS: Seventy-three patients who had undergone PEG were followed at 1 mo, 3 mo and 6 mo after feeding tube placement to determine the changes in white blood cell count, lymphocyte count, plasma hemoglobin, total protein, albumin, transferrin protein, body weight, and body mass index (BMI). The incidence of complications such as pneumonia and reflux esophagitis was also recorded. Changes in quality of life before and after PEG were measured with the Short Form 36 Health Survey questionnaire.

RESULTS: A total of 107 PEG procedures were performed in 73 patients. Nutritional status and weight loss were significantly improved after PEG. The levels of hemoglobin, total protein, albumin, transferrin, and body mass index significantly improved at 1 mo, 3 mo and 6 mo after enteral nutrition, showing significant differences before and after PEG (all P < 0.05). The incidence of pulmonary infection decreased from 63.0% preoperatively to 16.7% postoperatively, and that of reflux esophagitis decreased from 27.4% to 7.6%. At 1 mo, 3 mo and 6 mo after feeding tube placement, there was a significant improvement in patients' physical health and mental health, as well as physiological function, social function.

CONCLUSION: The nutritional status, levels of hemoglobin, total protein, albumin and transferrin, as well as body mass index significantly improved in patients after PEG. The incidence of complications and quality of life also improved in patients after PEG.

Gastrointestinal problems in the neurologically impaired child

Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux, with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding difficulty in disabled children. Early recognition of an infant with neurological impairment that is compromising the normal feeding process is crucial. Detailed assessment of the nature of the feeding difficulties will help to predict the anticipated future nutritional needs and will allow decisions to be made about the appropriateness of input from different professionals (speech therapy, dietitians, gastroenterologists). Only when such information has been carefully assembled will rational and directed medical and surgical therapy be possible. Nutritional rehabilitation of disabled children can be associated with increased mortality and morbidity secondary to gastro-oesophageal reflux, retching, dumping syndrome or aspiration. It may also entail an increased work for care givers and increase costs of care. It is therefore necessary to document the impact of such rehabilitation on growth and quality of life for both patient and care giver.