The effects of bolus and continuous nasogastric feeding on gastro-oesophageal reflux and gastric emptying in healthy volunteers: A randomised three-way crossover pilot study

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 27; no. 4; pp. 608 - 613
• Main Authors: Bowling, Tim E, Cliff, Brett, Wright, Jeff W, Blackshaw, P. Elaine, Perkins, Alan C, Lobo, Dileep N
• Format: Journal Article
• Language: English
• Published: Kidlington Elsevier Ltd 01.08.2008; Elsevier
• Subjects: Adult; Area Under Curve; Biological and medical sciences; Bolus; Cross-Over Studies; Drip; Enteral Nutrition - adverse effects; Enteral Nutrition - methods; Esophagus; Feeding. Feeding behavior; Fundamental and applied biological sciences. Psychology; Gastric Emptying - drug effects; Gastric Emptying - physiology; Gastric emptying time; Gastro-oesophageal reflux; Gastroenterology and Hepatology; Gastroenterology. Liver. Pancreas. Abdomen; Gastroesophageal Reflux - epidemiology; Gastroesophageal Reflux - etiology; Gastroesophageal Reflux - prevention & control; Humans; Infusions, Parenteral - adverse effects; Infusions, Parenteral - methods; Injections, Intravenous - adverse effects; Injections, Intravenous - methods; Intubation, Gastrointestinal - methods; Male; Medical sciences; Multichannel intraluminal impedance testing; Nasogastric feeding; Other diseases. Semiology; Pilot Projects; Respiratory Aspiration - prevention & control; Risk Factors; Scintigraphy; Time Factors; Tube feeding; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Volunteer study; Drip; Gastro-oesophageal reflux; Volunteer study; Nasogastric feeding; Bolus; Scintigraphy; Multichannel intraluminal impedance testing; Tube feeding; Gastric emptying time; Human; Gastroesophageal reflux; Stomach; Digestive system; Continuous; Volunteer; Esophageal disease; Gastric emptying; Metabolic diseases; Crossover study; Feeding; Randomization; Bolus injection; Nasogastric; Digestive diseases
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2008.04.003

Summary Background & aims Nasogastric feeding may result in gastro-oesophageal reflux and, therefore, increase the risk of aspiration. This may be greater when feeds are administered via a bolus than by infusion. We aimed to measure gastric emptying time and quantify gastro-oesophageal reflux in healthy volunteers given a liquid feed via an oral bolus (OB), a nasogastric tube bolus (TB) and a nasogastric tube drip (TD). Methods Twelve male volunteers participated in three separate studies (OB, TB and TD) in random order, each 3 days apart. The feed consisted of 220 ml Ensure Plus (1.5 kcal/ml), labelled with 12 MBq99m Tc DTPA. The OB and TB were given over 5 min and the infusion rate for the TD was 55 ml/h. Gastric emptying time was measured using gamma scintigraphy. Gastro-oesophageal reflux was observed continuously until the stomach was empty, using a multichannel intraluminal impedance catheter. Results Mean (95% CI) T50 gastric emptying times for the OB and TB studies were 41.3 (36.5–46.2) min and 36.2 (30.6–41.8) min respectively ( p = 0.19). The stomach emptied at a rate equal to the infusion rate in the TD studies. Median (IQR) number of reflux episodes for the OB, TB and TD studies were 4.5 (2.0–6.0), 3.0 (2.0–4.75) and 2.0 (0.25–6.25) respectively. Median (IQR) total duration of reflux for the OB, TB and TD studies were 38 (20–242), 49 (17–71) and 36 (1–125) s respectively ( p = NS). Conclusions The lack of difference in gastro-oesophageal reflux between bolus and continuous feeding indicates that in healthy volunteers both methods are equally safe with respect to the risk of aspiration.