Evaluation of nutritional status before and after PEG placement in patients with motorneuron disease

Background: Patients affected by amyotrophic lateral sclerosis (ALS, also known as motor neuron disease, MND) develop neurological dysphagia, which compromises their feeding capacity, hydration, and nutritional status. Since 1995, the use of percutaneous endoscopic gastrostomy (PEG) - or jejunal PEG inpatients with diaphragmatic hypomobility - to treat dysphagia has become increasingly common, with a positive impact on patients 'clinical condition. Recent opinion suggests that PEG should be performed before the vital capacity falls below 50% of predicted. Materials and methods: From January 2000 to December 2006, 36 patients affected by ALS were referred to us by our colleagues of the Neuroscience Department. The patients met the requirements for PEG placement of the American Academy of Neurology and they all accepted PEG. In all patients the "pull" method for PEG placement was used with a tube made ofpolyurethane (diameter 20 Fr). The pack system consisted of polymeric diets (25-35 Kcal/kg/day), which were modified if the patient continued to take food orally. Patients underwent nutritional status measurement before and after PEG placement (body mass index, anthropometry, chemical blood analyses). Results and conclusions: There were no deaths in our series, but we registered 3 cases of wound infection at the bumper. All patients showed considerable improvement in general condition and nutritional status, confirmed by nutritional status parameters. All these aspects confirm the appropriateness of our choice to perform PEG early in patients suffering from ALSMND, as this led to an improvement of quality of life and prolonged survival. © SINPE-GASAPE.