Assessment of intragastric pH value changes after early nasogastric feeding

Studies have suggested that early feeding after injury decreases morbidity and mortality. Few reports, however, have focused on the change in pH insid e the stomach after early tube feeding. The aim of the present study was th e assessment of 1) the change in intragastric pH after surgery, and 2) the effect of early nasogastric tube feeding on intragastric pH value. From Apr il 1997 to February 1998, 80 patients who underwent colon resection for col orectal cancer by a single surgeon entered the study and were randomized in to four groups. Twenty patients (group I) were kept on NPO for 1 wk, and 20 patients per group (groups II, III, and IV) were fed through a nasogastric tube from the second to the seventh postoperative day with low-residual (O smolite HN), high-fat (Pulmocare), and glutamine-containing (AlitraQ) enter al formulas. Feeding started at 500 kcal/500 cc/d. If the patient tolerated the formula well, feeding increased to 1500 kcal/1500 cc(-1)/d(-1) the fol lowing day. Intragastric pH was measured preoperatively and then twice dail y until the sixth postoperative day. The pH value of intragastric juice inc reased significantly once feeding started (3.67 +/- 1.33 on the third posto perative day; 4.28 +/- 1.26 on the six postoperative day). The pH value see med only mildly affected by the patient's tolerance for tube feeding (poorl y tolerated group, pH 3.52 +/- 1.75 versus 3.75 +/- 1.21 in the well-tolera ted group on the third postoperative day; poorly tolerated group, pH 3.67 /- 1.02 versus 4.45 +/- 1.27 in the well-tolerated group on the sixth posto perative day). The pH value of intragastric juice was higher in group IT th an in groups III and IV (4.51 +/- 1.57, 3.90 +/- 1.20, 4.42 +/- 0.89 respec tively, on the sixth postoperative day). This series suggests that early na sogastric feeding can significantly elevate the intragastric pH value in pa tients after resection of colorectal cancer. Nasogastric feeding may decrea se the incidence of stress ulceration by elevating the pH value of intragas tric juice. (C) Elsevier Science Inc. 2000.