2016 Volume 43 Issue 4 Pages 253-261
Dysphagia is a cause of aspiration pneumonia, and percutaneous endoscopic gastrostomy (PEG) has been widely used in elderly people who have difficulty with oral ingestion and have cerebral infarction, dementia, or general infirmity. PEG removes the need for oral ingestion and eliminates pneumonia caused by aspiration of food, but pneumonia may also reappear as one of the complications that can occur after PEG. In this study, we investigated: 1) the effects of PEG in suppressing the onset of pneumonia; 2) the relationship between pneumonia after PEG placement and aspiration caused by gastroesophageal reflux disease (GERD), using the presence or absence of endoscopic findings of reflux esophagitis or esophageal hiatal hernia as an index; and 3) the survival rate according to the presence or absence of pneumonia before and after PEG placement. We retrospectively studied 222 patients who underwent PEG tube placement at our hospital between January 2001 and December 2010 and were followed up regularly until December 2014. Patients were assessed on the basis of follow-up clinical examinations and self-reports. There were 119 patients in which pneumonia was observed before PEG placement, and 124 cases that developed pneumonia after placement, confirming that PEG tube placement did not reduce the onset of pneumonia. There were 55 cases of esophageal hiatal hernia and 41 cases of reflux esophagitis, and no significant difference was observed when associations between presence/absence of pneumonia before PEG tube placement and reflux esophagitis or esophageal hiatal hernia were investigated, but a significant association was shown in the presence/absence of pneumonia onset before and after PEG placement in cases that had reflux esophagitis or esophageal hiatal hernia (P < 0.05). Pneumonia was the most frequent final cause of death, and the survival rate was significantly lower in cases in which pneumonia was observed before PEG tube was inserted (P < 0.001). PEG tube placement does not appear to suppress the onset of pneumonia. The presence or absence of pneumonia before gastrostomy placement and the presence or absence of GERD were important predictors for pneumonia onset and for prognosis. Awareness of these factors is crucial for patient management after gastrostomy.
