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Gastroenterology (Expert Forum)
Gtube feeds/Motility/Retching
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Gtube feeds/Motility/Retching
by Myrna__0, Jul 02, 1998 12:00AM
My 3-yr old daughter was born with a congenital diaphragmatic
hernia and required ten days of ECMO. At 12-wks she had a g-tube
placed and a fundoplication was done. Somewhere along the way
she suffered a left CVA. She does not PO feed. She is fed
continuously at night and does not retch if the feeding stops
before she wakes. She retches after her two daytime boluses.
The retching occurs after or near the end of each feeding. We
vent her tube and get large amounts of gas and mucous back. Her
tongue sticks way out during the retching and stays out for
minutes to several hours. We are not sure if this is related to
her stroke or to the GI discomfort. We have tried many meds,
formulas, and feeding rates, all with no improvement. She is now
on Vivonex Pediatric & no meds. Her UGI's, gastric emptying
studies and endoscopies have all been normal. Her motility has
never been tested. Should she be tested for allergies? Are there
any other tests that we should have done? We live in Central
Florida, but are willing to travel to see a specialist.
_Dear Myrna,
When I read your communication several issues came to mind. Firstly, you mentioned that your daughter only gets retching during daytime bolus feedings. Why can't she get all of her calories at night by continuous pump feeds and forego the daytime bolus feedings? If she needs extra calories during the day you can try to feed by gravity at a slow rate or use the pump if that doesn't work. It is also important to feed your daughter in a sitting position and position her not lower than a 45-degree angle during the feeding. The retching may be a sign of gastroesophageal reflux and/or aspiration during the bolus feeding. During bolus feeding, a larger amount of enteral formula is present in the stomach and this may cause more reflux and subsequent aspiration into the lungs. If significant aspiration is present, sometimes placing a feeding tube into the jejunum (small intestine) may be helpful. Secondly, since your daughter had a CVA I think that it would be helpful to more carefully assess her swallowing. This can be done by obtaining a dynamic swallowing study to look for oropharyngeal dysphagia (swallowing difficulty secondary to poor function of the pharynx). Furthermore, esophageal manometry may help assess the adequacy of her fundoplication. You may also want to post this communication in the Maternal and Child Health Forum to get a pediatrician's perspective as well. Good luck to you.
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.
HFHSM.D.-ym
*Keywords: fundoplication, gastrostomy tube, enteral nutrition, aspiration, retching
Doctor's Answer
