LOWER ESOPHAGEAL SPHINCTER DYSFUNCTION PRECLUDES SAFE GASTRIC FEEDINGAFTER HEAD-INJURY

Early nutrition is advocated for patients with head injury to counter the postinjury hypermetabolic state. The gastric route of feeding ofte n leads to vomiting and aspiration pneumonitis. This study was designe d to identify the role of lower esophageal sphincter (LES) function in this complication. The LES function was assessed within 72 hours of a dmission in 16 patients with a head injury and a Glasgow Coma Scale (G CS) score less than 12 (range, 3-11). Other admission assessments incl uded an APACHE II score of 11.7, Injury Severity Score (ISS) of 30.5, and a Revised Trauma Score (RTS) of 6.4. These studies were repeated 1 week postinjury in five patients. Dysfunction of the LES was present in all 16 patients; the average gastric-to-esophageal pressure differe nce was -0.49 mm Hg (range, -0.59 to 2.5) compared with a normal value of greater than 20 mm Hg. The five patients restudied at 1 week had a gastric-to-esophageal pressure difference of 13.3 mm Hg (range, -3.4 to 36.6 mm Hg). The single patient with a GCS score below 12 at 1 week had a low LES tone. These data show that LES dysfunction accompanies acute head injury and contributes to aspiration pneumonitis after earl y gastric feeding. Nutrition in patients with low GCS scores should be parenteral or via the jejunum.