Cystic fibrosis patients often struggle to gain weight. Their appetites are poor and cannot fulfill their bodies’ high demand for calories, including the energy required to fight recurrent chest infections and the increased effort needed to breathe. Their bodies also are often unable to absorb nutrients properly.
Tube feeding, also called enteral feeding, can provide additional nutritional support and help patients gain weight, ingest enough calories, and maintain the required energy levels. It delivers nutrients directly into the stomach or intestine via flexible tubes using a pump.
Tube feeding is not a substitute for eating, but a supplemental nutrient source that can help patients gain weight and balance their nutrition. The goal of tube feeding is to provide 30 to 50 percent of a patient’s total energy needs.
CF patients may not need to use tube feeding long-term. Some discontinue use after they achieve the desired weight gain and can get enough nutrition by eating.
Types of feeding tubes
There are several different options available for CF patients, and varies by ease of use and the route of administration.
Nasogastric (NG) tubes
NG tubes are the least invasive of feeding tubes because they do not require an incision to be made. They are thin flexible tubes that deliver nutrients into the stomach via the nose. The tube is inserted into the nose, passed down through the throat and into the stomach.
Gastrostomy (G) tube
Also known as a percutaneous endoscopic gastrostomy (PEG) tube, a G tube is used to deliver nutrients directly into the stomach through a small incision in the abdomen. G tubes are the most commonly used feeding tubes.
A couple of months after the G tube is fitted, the patient can opt for a button to be placed at the site of insertion. This is called the “button” G tube. The button can be opened for administering medication and feedings. At all other times, it is kept closed.
Gastrostomy-jejunostomy (GJ) tube
A GJ tube is a flexible tube that delivers nutrients into a section of the small intestine called the jejunum. Through an incision in the abdomen, the tube is passed into the stomach and then into the jejunum.
Jejunostomy (J) tube
For patients who cannot tolerate stomach feeding, a J tube is used to provide nutrients directly into the jejunum, bypassing the stomach. A J tube is also inserted through a surgical incision in the abdomen.
The feeding formulas used in tube feeding are similar to infant formulas but modified to suit an adult’s energy requirements. The available nutrition formulas are generally rich in calories and designed to help the patient gain weight.
The feeding requirements for each patient can differ. Some may require the addition of enzymes to facilitate the absorption of nutrients, for example, while others may need a different formula because of allergies.
A dietitian can help determine the correct formula, required calorie level, feeding schedule, and inclusion of enzymes in tube feeding.
Feeding is most commonly scheduled to take place at night while the patient is asleep. This can help regulate food intake during the day.
Problems with tube feeding
The use of feeding tubes and formulas is generally safe. The most common issue reported is the feeling of being full during breakfast in the morning. This can be managed by adjusting the overnight feeding schedule such that feeding is stopped at least two hours before breakfast.
Other problems reported include nausea, vomiting, constipation, and diarrhea, which can be addressed by modifying the feeding formula.
Skin soreness around the tube insertion site may occur. Cleaning the skin with soap and warm water should help relieve the soreness.
Tube clogging can also occur, especially if the tubes are old. Flushing with warm water can help unclog the tubes.
A hospital stay may be needed for the first few days of tube feeding. In the case of G, J and GJ tubes, feeding may only be started about 24 hours after the placement of the tube to allow time for the incision site to heal. After the healing period, the doctor can offer guidance about the feeding process, and train the patient and their family about how to use the tube at home.
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