A patient with oral cancer on home bolus enteral feedings via gastrostomy tube reports abdominal pain and pressure inside the stomach, with no exterior site changes. What is the most appropriate next step?

• A. Refer the patient to the gastroenterologist or enterostomal nurse
• B. Increase the infusion volume
• C. Rotate the G-tube 180 degrees
• D. Change to slower gravity bag feedings

Answer: (B)

When a gastrostomy tube is causing abdominal pain and a sense of stomach pressure without external changes, the priority is to assess and correct a possible mechanical issue with the tube itself. Rotating the tube 180 degrees can relieve a pinch, kink, or malposition at the skin exit or along the tract, which can obstruct flow and lead to gas buildup and distension. If the tube is functioning after repositioning, the symptoms may resolve with careful monitoring and flushing to confirm patency.

Raising the infusion volume would increase gastric contents and likely worsen distension and discomfort, so it’s not a helpful move in this scenario. Slowing gravity-fed deliveries might reduce volume entering the stomach, but it doesn’t address a potential mechanical problem and could still fail to relieve distress if the tube is malpositioned. If symptoms persist after attempting repositioning, further evaluation by specialists would be warranted.