Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.

Hdl Handle:
http://hdl.handle.net/10147/209061
Title:
Nasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.
Authors:
Manning, B J; Winter, D C; McGreal, G; Kirwan, W O; Redmond, H P
Affiliation:
Department of Surgery, University College Cork, and Cork University Hospital,, Cork, Ireland.
Citation:
Surgery. 2001 Nov;130(5):788-91.
Journal:
Surgery
Issue Date:
3-Feb-2012
URI:
http://hdl.handle.net/10147/209061
DOI:
10.1067/msy.2001.116029
PubMed ID:
11685187
Abstract:
BACKGROUND: The routine use of nasogastric tubes in patients undergoing elective abdominal operation is associated with an increased incidence of postoperative fever, atelectasis, and pneumonia. Previous studies have shown that nasogastric tubes have no significant effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal reflux in the perioperative period. METHODS: A prospective randomized case-control study was undertaken in which 15 consenting patients, admitted electively for bowel surgery, were randomized into 2 groups. Group 1 underwent nasogastric intubation after induction of anesthesia, and Group 2 did not. All patients had manometry and pH probes placed with the aid of endoscopic vision at the lower esophageal sphincter and distal esophagus, respectively. Nasogastric tubes, where present, were left on free drainage, and sphincter pressures and pH were recorded continuously during a 24-hour period. Data were analyzed with 1-way analysis of variance. RESULTS: The mean number of reflux episodes (defined as pH < 4) in the nasogastric tube group was 137 compared with a median of 8 episodes in the group managed without nasogastric tubes (P =.006). The median duration of the longest episode of reflux was 132 minutes in Group 1 and 1 minute in Group 2 (P =.001). A mean of 13.3 episodes of reflux lasted longer than 5 minutes in Group 1, with pH less than 4 for 37.4% of the 24 hours. This was in contrast to Group 2 where a mean of 0.13 episodes lasted longer than 5 minutes (P =.001) and pH less than 4 for 0.2% of total time (P =.001). The mean lower esophageal sphincter pressures were lower in Group 1. CONCLUSIONS. These findings demonstrate that patients undergoing elective laparotomy with routine nasogastric tube placement have significant gastroesophageal reflux in the perioperative period and a reduced ability to clear refluxed acid from the distal esophagus. Due to the associated risk of postoperative pulmonary complications, we recommend that nasogastric intubation be performed on a selective rather than routine basis.
Language:
eng
MeSH:
Case-Control Studies; Esophagogastric Junction/physiology; Gastroesophageal Reflux/*etiology; Humans; Hydrogen-Ion Concentration; Intubation, Gastrointestinal/*adverse effects; Laparotomy; Prospective Studies
ISSN:
0039-6060 (Print); 0039-6060 (Linking)

Full metadata record

DC FieldValue Language
dc.contributor.authorManning, B Jen_GB
dc.contributor.authorWinter, D Cen_GB
dc.contributor.authorMcGreal, Gen_GB
dc.contributor.authorKirwan, W Oen_GB
dc.contributor.authorRedmond, H Pen_GB
dc.date.accessioned2012-02-03T15:11:13Z-
dc.date.available2012-02-03T15:11:13Z-
dc.date.issued2012-02-03T15:11:13Z-
dc.identifier.citationSurgery. 2001 Nov;130(5):788-91.en_GB
dc.identifier.issn0039-6060 (Print)en_GB
dc.identifier.issn0039-6060 (Linking)en_GB
dc.identifier.pmid11685187en_GB
dc.identifier.doi10.1067/msy.2001.116029en_GB
dc.identifier.urihttp://hdl.handle.net/10147/209061-
dc.description.abstractBACKGROUND: The routine use of nasogastric tubes in patients undergoing elective abdominal operation is associated with an increased incidence of postoperative fever, atelectasis, and pneumonia. Previous studies have shown that nasogastric tubes have no significant effect on the incidence of gastroesophageal reflux or on lower esophageal sphincter pressure in healthy volunteers. We hypothesized that nasogastric intubation in patients undergoing laparotomy reduces lower esophageal sphincter pressure and promotes gastroesophageal reflux in the perioperative period. METHODS: A prospective randomized case-control study was undertaken in which 15 consenting patients, admitted electively for bowel surgery, were randomized into 2 groups. Group 1 underwent nasogastric intubation after induction of anesthesia, and Group 2 did not. All patients had manometry and pH probes placed with the aid of endoscopic vision at the lower esophageal sphincter and distal esophagus, respectively. Nasogastric tubes, where present, were left on free drainage, and sphincter pressures and pH were recorded continuously during a 24-hour period. Data were analyzed with 1-way analysis of variance. RESULTS: The mean number of reflux episodes (defined as pH < 4) in the nasogastric tube group was 137 compared with a median of 8 episodes in the group managed without nasogastric tubes (P =.006). The median duration of the longest episode of reflux was 132 minutes in Group 1 and 1 minute in Group 2 (P =.001). A mean of 13.3 episodes of reflux lasted longer than 5 minutes in Group 1, with pH less than 4 for 37.4% of the 24 hours. This was in contrast to Group 2 where a mean of 0.13 episodes lasted longer than 5 minutes (P =.001) and pH less than 4 for 0.2% of total time (P =.001). The mean lower esophageal sphincter pressures were lower in Group 1. CONCLUSIONS. These findings demonstrate that patients undergoing elective laparotomy with routine nasogastric tube placement have significant gastroesophageal reflux in the perioperative period and a reduced ability to clear refluxed acid from the distal esophagus. Due to the associated risk of postoperative pulmonary complications, we recommend that nasogastric intubation be performed on a selective rather than routine basis.en_GB
dc.language.isoengen_GB
dc.subject.meshCase-Control Studiesen_GB
dc.subject.meshEsophagogastric Junction/physiologyen_GB
dc.subject.meshGastroesophageal Reflux/*etiologyen_GB
dc.subject.meshHumansen_GB
dc.subject.meshHydrogen-Ion Concentrationen_GB
dc.subject.meshIntubation, Gastrointestinal/*adverse effectsen_GB
dc.subject.meshLaparotomyen_GB
dc.subject.meshProspective Studiesen_GB
dc.titleNasogastric intubation causes gastroesophageal reflux in patients undergoing elective laparotomy.en_GB
dc.contributor.departmentDepartment of Surgery, University College Cork, and Cork University Hospital,, Cork, Ireland.en_GB
dc.identifier.journalSurgeryen_GB
dc.description.provinceMunster-

Related articles on PubMed

All Items in Lenus, The Irish Health Repository are protected by copyright, with all rights reserved, unless otherwise indicated.