The effect of jejunal meal feeding on gastroesophageal reflux

Background: Postprandial gastric distention is frequently associated with t ransient lower esophageal sphincter relaxation and gastroesophageal reflux (GER). Since the role of nutrient perfusion into the jejunum in inducing GE R is not well understood, we studied the effect of jejunal feeding on GER t hrough a percutaneous gastrojejunal tube in patients with and without reflu x esophagitis. Methods: Nine stroke patients with reflux esophagitis were f ed through a percutaneous gastrojejunal tube with either a liquid meal (2 k cal/2 ml/min) or saline for 2 h randomly on 2 separate days. An esophageal pH probe was placed 5 cm above the gastroesophageal junction to detect acid reflux. Six stroke patients without esophagitis were enrolled as controls. Results: In both the patients with esophagitis and the controls, esophagea l acid exposure (15.3% (4.9%-28.2%) versus 2.7% (0.0%-10.8%), P = 0.003; 5. 9% (0.5%-6.78) versus 0.0% (0.0%-1.5%), P = 0.01) and events of acid reflux (5 (1-16) versus 2 (0-8), P = 0.02; 12 (3-17) versus I (Olt), P = 0.02) we re significantly greater during jejunal meal feeding than during saline inf usion. Furthermore, in the reflux patients, but not in the controls, acid c learance time was also greater during jejunal meal feeding than during sali ne infusion (2.9 min (0.5-9.6 min) versus 0.7 min (0.0-4.3 min), P = 0.04). Conclusions: We therefore conclude that jejunal nutrient infusion without gastric distention can induce GER in both patients with reflux esophagitis and controls. This implies that GER induced by jejununal nutrients may in p art explain the incapability of jejunal tube feeding to prevent gastropulmo nary aspiration in patients at risk.