Individuals may experience difficulty eating and swallowing as ALS progresses, leading to malnutrition and dehydration. To ensure adequate nutrition and hydration, healthcare providers may recommend using feeding tubes. The information below aims to understand feeding tubes for people with ALS comprehensively.
What are feeding tubes?
A feeding tube, also known as a “g-tube,” is a device that can be used to support the nutritional needs of a person living with ALS. Feeding tubes are medical devices inserted through the nose or mouth and passed down through the throat into the stomach or small intestine. They are used to provide nutrition and hydration to patients who cannot eat or drink enough food and fluids to meet their nutritional needs.
The feeding tube is placed through the skin directly into the stomach, bypassing the mouth. When chewing and swallowing become difficult, a feeding tube can help supplement nutrition, calories, and hydration. Feeding tubes are recommended on an individual basis, usually when a person is experiencing significant difficulties with swallowing, decreased respiratory function with increased risk of aspiration, and/or if they have lost more than 10% of their initial body weight.
Types of feeding tubes
There are several feeding tube types, but the most common types used for people with ALS are nasogastric (NG) and percutaneous endoscopic gastrostomy (PEG) tubes.
Nasogastric (NG) tubes
NG tubes are inserted through the nose and passed down the throat into the stomach. They are usually recommended for short-term use, such as during hospitalization, and can be removed once the patient can eat and drink normally again.
Percutaneous endoscopic gastrostomy (PEG) tubes
PEG tubes are inserted through a small incision in the abdomen and passed directly into the stomach. They are recommended for long-term use and can remain in place for several months to years.
Benefits of feeding tubes
Feeding tubes can provide several benefits for people with ALS, including:
Providing adequate nutrition and hydration to prevent malnutrition and dehydration
Allowing patients to continue to receive nutrition and hydration even when they are unable to eat or drink normally
Reducing the risk of aspiration pneumonia, which can occur when food or liquid enters the lungs instead of the stomach
Improving the overall quality of life by reducing the stress and discomfort associated with eating difficulties
Reduces risk of choking due to chewing and swallowing problems
Improves nutrition and weight maintenance
It can be used to administer medication
Reduces the stress and exhaustion associated with eating food by mouth
Allows the person to enjoy food for pleasure without pressure to eat a certain amount
Can help to reduce weight loss
May prolong survival if placed early
Risks and Considerations
While feeding tubes can provide several benefits for people with ALS, there are also some risks and considerations to keep in mind, including:
Risk of complications, such as infection at the insertion site
Must maintain the tube and ensure it is clean (flushing)
You may require assistance to manage the equipment
Feeding formula and equipment costs may not be fully covered (ask your healthcare provider for guidance)
Complications related to the insertion of the feeding tube, such as bleeding, infection, or perforation of the intestine
Discomfort or pain associated with the feeding tube, which can interfere with daily activities and quality of life
Potential for dislodgement or malfunction of the feeding tube, which can require emergency medical attention
The Procedure
A gastroenterologist or an interventional radiologist typically performs feeding tube insertion as an outpatient or inpatient procedure requiring a local anesthetic and mild sedation. The procedure may require a short hospital admission if your breathing capacity is reduced. If you have a BiPAP machine and/or a Cough Assist Device, it is advisable to bring them to the hospital for this procedure.
Eating and Feeding Tubes
Many people with ALS can continue to eat normally for some time while they have a feeding tube. Some people use the feeding tube to supplement daily intake, while others use it only for fluids and medication. Even if not used immediately for nutrition, the feeding tube must be flushed daily with water to keep it clean. A dietitian will work with you to determine the type and amount of formula you will need to maintain an appropriate weight and adequate level of nutrition.
Feeding tubes can be an essential tool for people with ALS who are experiencing difficulty with eating and swallowing. They can provide adequate nutrition and hydration, reduce the risk of complications, and improve overall quality of life. However, it is important to carefully consider the risks and benefits of feeding tubes before making a decision and to work closely with healthcare providers to ensure proper use and care of the feeding tube.
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