This study reports our experience with the placement and long-term follow-up of 26 percutaneous endoscopic jejunostomy (PEJ) tubes in 23 patients over a 2-year period. Eighty-four percent of the PEJ tubes failed and were functional for an average of only 39.5 days. The reasons for failure were: (1) separation of the inner PEJ tube from the outer gastrostomy tube (59%); (2) clogging (32%) due to small PEJ tube diameter; and (3) kinking and knotting (9%). Upper gastrointestinal bleeding occurred in 30% of the patients (7 of 23). Only one patient required blood transfusions (2 units). The etiology of the bleeding was not determined. These patients had a previous history of acid-peptic disease and bleeding occurred despite cimetidine treatment. In contrast, only 1 of the 16 nonbleeding patients had acid-peptic disease (p less than 0.0001) and none were on cimetidine. The frequency of aspiration pneumonia decreased from 13 episodes during nasogastric tube feedings to 5 episodes during PEJ tube feedings. Improvement in the design of the PEJ tubes may increase the longevity and effectiveness of the tubes.

Aged↗

PubMedDate not supplied

Battery ingestion and EKG interference.

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Adult↗

PubMedDate not supplied

Irritable bowel syndrome and dysthymia. Is there a relationship?

Irritable bowel syndrome (IBS) has been reported in 10% to 22% of adults. The authors compared patients seeking treatment for dysthymia (N = 59) in an outpatient setting to an age- and sex-matched comparison group of patients (N = 54) seeking treatment in a general physician's office for other medical illnesses. The comparison group did not have any Axis I disorders. IBS was diagnosed by using the criteria established by Drossman and colleagues. Of the patients screened, 59.32% of the patients with dysthymia met criteria for IBS in contrast to 1.85% of the comparison group (P < 0.000005). IBS is extremely prevalent in patients seeking treatment for dysthymia and is often undiagnosed and untreated.

Adult↗

PubMedDate not supplied

Managed care: gag clauses and doctor-patient communication: state responses.

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Contracts↗

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Intestinal obstruction from cecal bezoar; a complication of fiber-containing tube feedings.

Dietary fiber increases stool bulk, regulates bowel transit time, and decreases intraluminal pressure. Because these actions constitute a natural way to stop diarrhea, a frequent problem with tube feedings, enteral tube feeding manufacturers have marketed several fiber-containing formulae. While bulk-forming agents such as fiber may not be appropriate for every tube-fed patient, we were unable to find any published contraindications to the use of fiber-containing enteral products. We present the case of a seriously ill man who received a fiber-containing tube feeding while also getting intestinal motility-suppressing medications. A large fiber bezoar developed, with resultant mesenteric hemorrhage. We conclude that fiber-containing tube feedings are contraindicated in certain types of patients.

Bezoars↗