The Effect of Viscosity Regulating Solution for Enteral Nutrition Against Gastro Esophageal Reflux

Isao Tabei, Hirotaka Kubo, Fumiaki Yano and Haruo Inada*

Department of Surgery, Jikei University School of Medicine
Nakaizu Rehabilitation Cente*

Care is needed in administering enteral nutrition (EN). If administered to fast in a misguided attempt to save time, it may cause severe diarrhea, malnutrition, and other metabolic disorders, and worst of all aspiration pneumonia. We developed a pectin solution easily added to conventional EN solution to modulate viscosity, enable recipients to be given EN administered in a short time while preventing aspiration pneumonia, enabling them to have more time to recover. Subjects and Methods: We studied changes in viscosity of conventional EN solution (K-3S) containing 60 mg of calcium ion when 90g of viscosity regulating gel forming pectin solution (REF-P1) was added. Four healthy volunteers were rapidly administered EN and the influence of viscosity alternation by supplementary REF-P1 against gastro esophageal reflux was monitored by gastro esophageal pH. Preliminary clinical study was carried out using K-3S and REF-P1 at 9 institutions in 16 patients with repetitive aspiration under EN management is introduced. Results: The addition of Ref-P1 to conventional EN solution increased viscosity from 8 centi pores (cp) to 860 cp. Rapid administration of K-3S to healthy volunteers caused gastro-esophageal reflux prevented by supplementary REF-P1 with viscosity elevation. The reflux rate (%) for K-3S alone was 2.1%. The reflux rate with REF-P1 added decreased to 0.3%. The usage of REF-P1 ameliorated reflux aspiration during EN administration, and decreased the incidence of vomiting, diarrhea, and febris. Summary: We focused on improving EN management by elevating the viscosity of K-3S to prevent aspiration. K-3S forms a gel in the stomach through additional REF-P1 and prevents gastro esophageal reflux disorder (GERD) resulting in aspiration pneumonia. It also shortened administration. This is thus useful in managing EN and gives patients more time to recover.

Key words
pectin, enteral nutrition, aspiration pneumonia, gastro-esophageal pH-monitoring, viscosity

Reprint requests
Isao Tabei Dept. of Surgery, Jikei University Kashiwa Hospital 163-1 Kashiwashita, Kashiwa-city, 277-8567 JAPAN

Accepted
November 27, 2002

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