Modulation of tube feeding protocol to prevent aspiration pneumonia in gastroesophageal reflux

Background & Aims Aspiration pneumonia, as an enteral tube feeding-related complication, interferes with nutritional administration, and gastroesophageal reflux (GER) is a well-known cause of this problem. One of the factors that induces GER and other abdominal symptoms is gastroparesis, which is a syndrome caused by delayed gastric emptying (DGE) without mechanical obstruction.High-viscosity formulas are reportedly effective in suppressing GER, and there are new formulas that further increase viscosity and change phase from liquid to semisolid in the stomach, which can be used even with small-diameter tubes such as nasogastric tubes. The management of gastroparesis is useful for preventing aspiration pneumonia. To achieve this, post-pyloric feeding has been recommended, but this needs additional skill and facilities. An elemental diet can hasten pyloric transit and decrease GER, but has less tolerability due to diarrhea. A new nutritional liquid formula containing ingredients fermented by lactic acid bacteria has been introduced and is expected to have rapid pyloric transit (similar to the elemental diet). Thus, this may be useful in the management of GER patients with gastroparesis.This retrospective study evaluated whether the modulation of nutritional formulas using the new materials contributes to the prevention of tube feeding-related complications such as aspiration pneumonia. Methods In patients with tube feeding-related complications, upper gastrointestinal series was performed to assess the gastrointestinal motility. In cases with abnormal motility, we made the modulation of formulas using the aforementioned new types. The effectiveness of the modulation was evaluated by the frequency of aspiration pneumonia, changes in nutritional status and the period of feeding interruption in one year. Results Modulation of the tube feeding protocol significantly reduced the incidence of aspiration pneumonia. Tube feeding could be properly continued without any interruption and nutritional status could be recovered and maintained. Conclusions Modulation of the tube feeding protocol including the formulas based on gastrointestinal motility status can reduce tube feeding-related complications.