What is the risk of nocturnal supine enteral nutrition?

One complication of enteral nutrition (EN) is gastro-esophageal reflux disease. Semi-recumbent position is advised because posture influence reflux in critically ill patients. No data is available in stable patients. Aim To study influence of position on reflux during nocturnal nutrition by percutaneous endoscopic gastrostomy in stable patients. Methods Prospective cross-over study. Reflux was measured by 48 h-pH-metry, in supine and semi-recumbent position. The end point was % time spent under pH 4. For analysis, 2 subgroups were identified (refluxers and non-refluxers). A total of 16 patients (65 year±13) were included, most had neurological diseases. Results There was no increase of reflux probability in any position in all patients (% time spent under pH 4: supine vs. semi-recumbent: 4.4±7.7 vs. 3.5±7.0 NS). In non-refluxers, supine position did not increase % time under pH 4 (0.1±0.12 vs. 0.3±0.6, NS), and did not modify other parameters (number of reflux 0 ±0.9 vs. 7 ±19 NS, duration of the longest reflux (min) 1.1±1.7 vs. 1±1.7 NS). In refluxers, supine position did not worsen pre-existent reflux (% time under pH 4: 11.7±8.7 vs. 8.9±9.7 NS, number of reflux 119±88 vs. 91±89 NS, duration of the longest reflux (min) 19±19 vs. 24±21 NS). Conclusion Our data suggest that position does not influence reflux in stable patients with EN.