Tube feeding/reflux

  I ma a SLP who has just recieved a referral for a 29 year old man.
  He has an undiagnosed condition which has resulted in seizures and dysphagia. He is on a Jtube and is fed with Complete. His family report 1 He is not gaining weight. 2. He seems to do better on glucose than food supplements. Glucose of course does not supply nutrition. 3. There is reflux of a white milky substance in the back of the pharynx, this causes him to cough and "gurgle". Heis lungs are deemed to be clear. He is in a hospital bed which is kept at an appropriate angle. 4. he is developing thrush as his mouth is dry, they are flushing the system with water as instructed by the physician. they use slow  frequent,flushing to prevent discomfort.
  Is there anything else the family can do to prevnet or minimize the reflux? They are also concerned about his lack of weight gain. Interestingly enough he appear to do well on new formulas, and then increases lseizures and lethargy once his body becomes accustommed to them.
  HELP!
Dear Lina,
Thank you for your recent posting. In theory, patients on jejunostomy tube feeds should not have a residual volume or reflux
secondary to the tube feedings. However, his underlying condition may be associated with reflux and oropharyngeal dysphagia.
Patients on jejunostomy tube feeds should be fed by pump and not with bolus feeds. His reflux may be exacerbated by
Candida esophagitis (since you noted that he has oral thrush). Aggressive treatment for fungal infection may improve his
dysphagia and reflux. Treating and defining his underlying condition(if possible) may also improve his overall condition. Some
patients with tube feeding associated reflux do better with prokinetic agents (agents that accelerate gastric emptying) such as
cisapride (Propulsid) or metaclopramide (Reglan). Acid suppressing medication such as histamine receptor antagonists
(ranitidine) or proton pump inhibitors (omeperazole) may also provide symptomatic relief. In terms of weight gain, it is more
important at this stage to prevent further weight loss than to worry about weight gain. If your patient does well on a particular
tube feeding formula for only short periods, it may be helpful to rotate the enteral formulas.It is also important to re-evaluate the
position of the feeding tube to make sure it is in its proper place. In patients with a gastrostomy tube sometimes placing the tube
further down in the jejunum may alleviate reflux type symptoms. I hope you find this information helpful.
This response is being provided for general informational purposes only and should not be considered medical advice or
consultation. Always check with your personal physician when you have a question pertaining to your health.
If you wish to be seen at our institution, please call 1-800-653-6568, our Referring Physician's Office and make an
appointment to see Dr. Muszkat, one of our experts in Gastroenterology.
HFHSM.D.-ym
*Keywords: gastroesophageal reflux, tube feeding

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