A patient with oral cancer on home bolus enteral feedings via gastrostomy tube develops stomach pain after starting feeding; choose best management:

• A. Tell the patient to take over the counter pain medication and rotate the G tube 180 degrees each day
• B. Decrease the infusion volume of the formula
• C. Refer the patient to the gastroenterologist or enterostomal nurse
• D. Change to a slower tube feed infusion by using a gravity bag

Answer: (C)

When new stomach pain occurs after starting gastrostomy tube feeding, the priority is to assess for tube-related problems and feeding intolerance with a professional who can evaluate the tube’s function and placement. A gastroenterologist or an enterostomal nurse has the expertise to inspect the tube site, check tube patency and position, and identify mechanical issues such as dislodgement, blockage, or kinking, as well as potential gastric or tube-related complications. They can order or perform the appropriate diagnostics and guide any necessary interventions, such as tube adjustment, replacement, or feeding plan modifications.

Telling the patient to use over-the-counter pain medication and rotating the tube, decreasing the feeding volume, or using a gravity bag are not ideal first steps because they either mask the underlying issue or delay proper assessment. The best course is a professional evaluation to determine the cause of the pain and ensure safe, effective feeding.