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An evaluation of percutaneous endoscopic gastrostomy feeding in AIDS
1Department of Clinical Nutrition, St James's Hospital, Dublin, Republic of Ireland.
Insights
Percutaneous endoscopic gastrostomy (PEG) feeding improved nutritional intake and weight in AIDS patients. Most patients found PEG feeding acceptable, preferring it over nasogastric (NG) feeding.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Clinical Nutrition
Background:
- Acquired Immunodeficiency Syndrome (AIDS) often leads to malnutrition and cachexia.
- Enteral feeding is crucial for managing nutritional deficits in advanced HIV/AIDS.
- Percutaneous endoscopic gastrostomy (PEG) offers a long-term solution for nutritional support.
Purpose of the Study:
- To evaluate the safety and efficacy of PEG feeding in patients with advanced AIDS.
- To assess nutritional and anthropometric changes following PEG insertion.
- To determine patient acceptance of PEG feeding compared to nasogastric (NG) feeding.
Main Methods:
- A cohort of 17 AIDS patients received PEG feeding between October 1991 and October 1993.
- Indications included severe anorexia, esophageal candidiasis, and absent gag reflex.
- Nutritional intake, weight, anthropometric variables, and complications were monitored; patient-reported outcomes were assessed via questionnaire.
Main Results:
- Significant increases in energy and protein intake (P < 0.001) and weight gain (mean 2.6 kg, P < 0.01) were observed at 2 months.
- One PEG site infection was the only complication in patients followed > 2 months.
- Patients who died within 6 weeks were older with lower serum albumin compared to survivors (P < 0.01).
Conclusions:
- PEG feeding is a safe and effective method for nutritional rehabilitation in selected AIDS patients.
- It leads to significant improvements in nutritional status and is well-tolerated.
- PEG feeding is preferred by most patients over NG feeding, enhancing quality of life.
Abstract:
Between October 1991 and October 1993, 17 AIDS patients (14 intravenous drug users, 3 sexually acquired) were commenced on percutaneous endoscopic gastrostomy (PEG) feeding in St James's Hospital. Indications were progressive weight loss related to severe anorexia, persistent oesophageal candidiasis (5) and absence of gag reflex (1). Two patients requested PEG tube removal after one week because of crampy abdominal pain without peritonitis. Five patients died from AIDS related infections within 6 weeks of PEG insertion. Ten patients were followed up for > 2 months (mean 5.2 months, range 2.5-15.5 months). In these 10 patients, 1 patient developed a PEG site infection which responded to topical antibiotics. There were no other complications. There was a significant (P < 0.001) increase in energy and protein intake at 2 months. Variant degrees of weight gain occurred in all patients (mean 2.6 kg) (P < 0.01). Small but significant increases in other anthropometric variables occurred. Patients who died within 6 weeks of PEG insertion were older, and had a lower serum albumin than the group who survived > 2 months (P < 0.01). A self-administered questionnaire demonstrated that the majority of patients found PEG feeding acceptable and preferable to nasogastric (NG) feeding.