Efficacy of Semi-Solid Nutrients on Gastroesophageal Reflux Symptoms in Neurologically Impaired Patients Evaluated Using Multichannel Intraluminal Impedance-pH Monitoring: A Report of Two Cases

Gastroesophageal reflux (GER) is a common and serious complication in patients receiving enteral nutrition, which can make continuing enteral feeding difficult. Semi-solid enteral nutrition confers the advantage of reducing the risk of diarrhea and GER; however, despite its widespread use in Japan, limited published data are available on this method. Here, we report two neurologically impaired patients whose GER symptoms improved with semi-solid nutrient administration. Multichannel intraluminal impedance-pH (MII-pH) monitoring was used to evaluate GER progression. The first patient, a 47-year-old man with severe scoliosis and a history of endoscopic submucosal resection for cardioesophageal cancer, was referred to our hospital for vomiting. He was treated with a potassium-competitive acid blocker and semi-solid nutrients (RACOL®-NF Semi-Solid for Enteral Use, EN Otsuka Pharmaceutical Co., Ltd., Hanamaki, Japan), which helped manage GER episodes. The second patient, a 9-year-old boy with repeated aspiration pneumonia, was referred for vomiting. MII-pH monitoring showed that bolus infusion of liquid nutrients by his caregiver aggravated his GER. However, switching to semi-solid nutrients alleviated his GER symptoms. These case studies suggested that semi-solid nutrition may be a useful alternative for managing GER symptoms in patients experiencing difficulties with liquid nutrition.