Comparison of Percutaneous Endoscopic Gastrostomy, Megestrol Acetate and Nasogastric feeding in adult patients with Cystic Fibrosis

Background/Aims: Malnutrition remains an important and common problem in cystic fibrosis (CF) patients. In adult CF patients, weight loss is associated with poor lung function, and nutritional status has been found to be an independent predictor of mortality. We compared changes in weight and forced expiratory volume in 1 s (FEV1) in patients with CF receiving one of three interventions to encourage weight gain: i) oral megestrol acetate (MA); ii) nasogastric (NG) tube feeding; iii) percutaneous endoscopic gastrostomy (PEG), Our aim was to determine and compare the effectiveness of these interventions in i) stabilising weight and ii) stabilising FEV1 in CF adults. Methods: We retrospectively collected data from hospital records of patients attending the Manchester Adult Cystic Fibrosis Centre (MACFC) between June 1998 and June 2012. We included adult patients with CF on any of the three nutritional interventions. Decisions regarding requirement for, and type of feeding intervention were made on a case by case basis by a multidisciplinary team with the choice of feeding intervention depending on MDT opinion and willingness of the patient for each intervention. Results: 53 patients fulfilled inclusion criteria with 12 month follow-up data (17 MA, 14 NG and 22 PEG). Patients showed significant weight gain from baseline for two of the interventions: MA (mean change 2.7 kg, 95% CI 0.5, 5.0) and PEG (mean 2.5 kg, 95% CI 0.7, 4.3). For NG mean weight gain was 2.0 kg (95% CI -0.2, 4.3) which did not reach statistical significance (p=0.073) Analysing change in weight between the interventions no statistically significant differences were identified. Lung function remained stable with small non-significant FEV1 changes over the 12 months: MA (mean change 0.09, 95% CI -0.08, 0.26), NG (mean 0.02, 95% CI -0.21, 0.26) and PEG (mean 0.04, 95% CI -0.12, 0.21, p=0.58). No statistically significant differences in FEV1 changes were found between the interventions. Conclusion: This is the first study to compare 3 different interventions in CF adults. All three interventions appear to be equally effective means of improving nutritional status in this 12 month study. Lung function remained stable but did not improve.