What is the etiology of gastric ulceration associated with PEG tube placement?

• A. Excessive tension between the external and internal bolsters causing erosion and bleeding
• B. Bacterial infection of the gastric mucosa
• C. Ischemia due to reduced gastric blood flow
• D. Allergic reaction to the tube material

Answer: (A)

The main idea is that PEG-associated gastric ulceration usually results from mechanical pressure, not infection or systemic issues. When the external bolster is tightened too tightly, the tube pulls on the internal bumper against the gastric mucosa. This sustained local pressure compresses the stomach lining, leading to ischemia, erosion, and eventually an ulcer with potential bleeding. This pressure-related, focal injury is the most direct and common cause in this setting. Bacterial infection, generalized ischemia of the stomach, or an allergic reaction to tube material would produce different patterns of disease and are not the typical driver of a PEG-related gastric ulcer.