Definition and Overview

Gastrostomy feeding is a method of providing nutrition directly into the stomach through a surgically created opening (stoma) in the abdominal wall.

A gastrostomy tube (G-tube) is inserted through this opening and held in place by an internal balloon or bumper and an external fixator. This method is used when a patient is unable to safely or adequately consume food orally.

Indications for Gastrostomy Feeding

Gastrostomy feeding may be indicated when a patient has:

1. Impaired Swallowing:

• Dysphagia: Difficulty swallowing due to neurological conditions (e.g., stroke, brain injury), muscular diseases, or structural abnormalities of the mouth, throat, or esophagus.

• Aspiration Risk: High risk of food or liquids entering the airway, potentially leading to aspiration pneumonia.

• Esophageal Obstruction: Blockage of the esophagus due to tumors, strictures (narrowing), or other causes.

• Carcinoma of the Esophagus: Cancer affecting the esophagus.

• Birth Defects: Congenital abnormalities of the mouth or esophagus that impair swallowing.

• Esophageal Atresia: A birth defect where part of the esophagus is missing or closed off.

• Problems with Sucking or Swallowing: In patients with debilitating diseases like stroke and dementia

• Operations of the Upper Gut: Procedures involving the alimentary canal, mouth, nose, and esophagus.

2. Prolonged Malnutrition or Inadequate Oral Intake:

• Chronic Illness: Conditions like cancer, Crohn’s disease, or cystic fibrosis that lead to long-term nutritional deficiencies.

• Anorexia Nervosa: An eating disorder characterized by severe food restriction and weight loss.

• Severe Weight Loss: Inability to maintain adequate weight and nutritional intake through oral means.

3. Impaired Digestion and Absorption:

• Short Bowel Syndrome: A condition where a significant portion of the small intestine is missing or non-functional, impairing nutrient absorption.

• Malabsorption Disorders: Conditions like celiac disease that interfere with the absorption of nutrients.

4. Delayed Gastric Emptying:

• Gastroparesis: Delayed stomach emptying, often due to nerve or muscle dysfunction.

• Medication-Induced: Certain medications can slow down gastric emptying.

5. Altered Level of Consciousness:

• Severe Brain Injury: Patients who are unconscious or unable to swallow safely due to a brain injury.

• Chronic Vegetative State: A state of persistent unconsciousness with no awareness.

6. Chronic Vomiting or Reflux:

• Severe Gastroesophageal Reflux Disease (GERD): Persistent vomiting and acid reflux that lead to malnutrition.

• Intractable Vomiting: Persistent vomiting that does not respond to medical treatment.

7. Premature Infants:

• Prematurity: Infants born before 37 weeks gestation may have immature digestive systems and require tube feeding.

• Failure to Thrive: Infants who are not gaining weight or growing adequately.

Methods of Gastrostomy Feeding

1. Bolus Feeding: Administration of a specific volume of liquid feed over a short period (e.g., 15-20 minutes), often using a gravity set to control the flow rate.

2. Continuous Feeding: Delivery of a constant, regulated amount of liquid feed over a longer period using an electronic feeding pump. This method ensures a steady flow of nutrients into the stomach