What can be done to cut down or cut out reflux from tube feeding?

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ri3smom Asked January 2019

What can be done to cut down or cut out reflux from tube feeding?

My brother-in-law is fed through a g-tube in his stomach. He starts coughing and gagging sometimes almost as soon as we start feeding him but other times half way through or right at the end of the feeding. He has a very pained look on his face when this happens but he also causes the food to flow out of the syringe at times or clogs his tube. Is there anything that can be done to help with this? We have changed his food one time and changed his feeding schedule but so far it has not made a big difference. It seems to be getting worse. Thanks for any advice or suggestions.

Diet & Nutrition Feeding Tube

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score 0 · Answer 1

OP has not responded since asking the question back in January.

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score 1 · Answer 2

There is a surgical option that will reduce/prevent reflux after a g-tube placement. I have had many patients undergo the procedure at the same time as a gastrostomy tube. It is called a Nissan Fundoplication. A small part of the stomach is used as a wrap at the end of the esophagus. Tests are done beforehand to determine the length and tightness needed. It can be done with a laparoscope. Medications reduce acid but do not prevent the back-up of stomach contents into the esophagus. One patient had an extensive history of aspiration pneumonia. G-tubes do NOT prevent aspiration. This patient had a fundoplication 20 years ago, no g-tube. She has not had a single aspiration pneumonia since. She is in her mid-80's.
This procedure creates a physical barrier. Remember that acid reflux damages the mucosal lining of the esophagus. Then contents can come up higher and higher. It can occur to the point that reflux enters the lungs causing tissue damage. If it happens while sleeping, the person may wake up gasping for breath. Acid reflux causes the vocal folds to spasm shut, which closes the airway.
Anyone with a g-tube needs conscientious oral hygiene 3 to 4 times a day. Poor oral hygiene is a risk factor for aspiration pneumonia, bacteria from the mouth can enter the lungs.
The average PCP does not recognize the value of a fundoplication. You must find an experienced surgeon.

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score 0 · Answer 3

Thank you for your help. My BIL sits up when he eats most of the time and when he is in bed, he is elevated at least 30 degrees. He won't leave his bed elevated all the time though so that's one reason he has trouble, but even when he is sitting up he has trouble. Standing helps but he has to stand for at least 5 minutes or stand up and down a few times until he is better. His doctor has not been a big help. He doesn't have a health team any more. We no longer receive home health services.

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Just read your profile and see more about the situation. Wow, you’re really going the extra mile with BIL. My mother’s stroke took every physical ability, she couldn’t sit, roll over, talked very little and eventually lost that entirely, literally couldn’t do anything. There was no possible way to provide the level of care she required in home so we used a nursing home. We were blessed to find one that was good and caring. The g-tube was placed when we were told there was great hope of recovery, it never came despite tons of therapy. Sounds like your BIL can do more since he can stand. Is he verbal? When this gets to be too much, and it will, it’s okay to have him move into nursing care. It’s never what anyone wants but there comes a point where you have to care for yourselves and prevent your own health issues. For now it sounds like you need a new doctor for him. Blessings to you as you walk this path, it’s so hard...

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score 1 · Answer 4

My mother was fed with a g-tube following a stroke. We had to do several changes of food to find the one she tolerated best. Also, the doctor should be aware of this. There may be a med that will help with reflux issues.

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Thank you for your response. My brother in law's doctor is aware of this issue but she doesn't offer any assistance with it except to suggest we reduce the amount of food he receives at one time and maybe feed him less more often. We also saw a gastroenterologist and he did not offer any help. We no longer receive home health services so we are in this alone. He takes omeprazole to help with reflux but it doesn't help. He does OK for a while when he first starts a food and then it gets worse. He has been on this food for about 8 months now. Without a nutritionist or someone to help we don't have any idea nor does his doctor about what to do. We will suggest she refer us to a nutritionist and perhaps that professional can help with switching the food to some other type. Thank you again for sharing your experience.

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score 1 · Answer 5

Sorry, I know nothing about tube feeding but I'll bump up your question so more people will see it.
Just some thoughts - is he sitting upright or does he at least have the bed elevated? What does his healthcare team have to say?

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What can be done to cut down or cut out reflux from tube feeding?

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