Causes of Gastrostomy

Introduction

A gastrostomy is a medical procedure in which a feeding tube is inserted directly into the stomach through the abdominal wall. It is commonly done when a person cannot eat or swallow safely through the mouth. While the procedure itself is straightforward and widely used, many people wonder why a gastrostomy becomes necessary in the first place. Understanding the causes of gastrostomy helps families prepare for the procedure, support the patient, and know what to expect in the long term.

What Is Gastrostomy and Why Is It Performed?

A gastrostomy tube (commonly called a G-tube or PEG tube when placed endoscopically) provides long-term nutritional support. It is recommended when a patient cannot maintain adequate nutrition, hydration, or medication intake through normal swallowing.

Doctors usually consider a gastrostomy when

1. Swallowing is unsafe and may lead to choking or aspiration
2. Eating enough food orally is impossible or extremely difficult
3. Long-term enteral feeding is required for months or years
4. A patient requires direct access to the stomach for decompression

The causes of gastrostomy are diverse and depend on age, underlying disease, and overall health condition. Below are the most common medical reasons why doctors recommend a gastrostomy tube.

Causes of Gastrostomy

1. Neurological Disorders That Affect Swallowing :- One of the most common reasons for gastrostomy placement is neurological impairment. When brain or nerve function is affected, the ability to swallow safely may be compromised.

Common neurological conditions requiring gastrostomy include

• Stroke (Cerebrovascular Accident): Many stroke survivors experience dysphagia (difficulty swallowing), which may lead to aspiration pneumonia. If recovery is slow, a gastrostomy ensures safe nutritional support.
• Traumatic Brain Injury: Damage to motor control centers can impair swallowing reflexes.
• Cerebral Palsy: Children with severe motor impairment often require long-term tube feeding to maintain proper nutrition.
• Neurodegenerative diseases: Conditions like ALS (Amyotrophic Lateral Sclerosis), Parkinson’s disease, and Multiple Sclerosis may gradually weaken swallowing muscles.
  

In these cases, a gastrostomy helps prevent malnutrition, dehydration, and lung complications caused by food entering the airway.

2. Head and Neck Cancers :- Patients undergoing treatment for head and neck cancers often face extreme difficulty chewing and swallowing.

How cancer leads to gastrostomy

• Tumors in the throat, mouth, or esophagus obstruct the passage of food.
• Radiation therapy may cause severe inflammation, dryness, or ulceration.
• Surgery for cancer may temporarily or permanently impair swallowing.

A gastrostomy tube allows patients to maintain adequate nutrition throughout their treatment, which is essential for healing, immunity, and energy.

3. Congenital Abnormalities in Infants and Children :- For some newborns and children, gastrostomy is required early in life due to structural or functional abnormalities.

Common causes include

• Cleft palate or craniofacial deformities that make breastfeeding or bottle-feeding difficult
• Esophageal atresia (incomplete formation of the esophagus)
• Neuromuscular disorders affecting swallowing coordination
• Genetic or metabolic disorders that impair feeding or increase energy requirements

When oral feeding is unsafe or insufficient, a gastrostomy ensures proper growth and development.

4. Severe Swallowing Disorders (Dysphagia) :- Dysphagia can result from various causes besides neurological conditions.

Other reasons for severe dysphagia include

• Aging-related muscle weakness
• Post-surgical complications
• Throat injuries
• Inflammation or scarring of the esophagus

Patients who repeatedly aspirate food or liquids into their lungs are at risk of pneumonia, making gastrostomy a safer long-term alternative.

5. Digestive System Blockages or Narrowing :- Physical blockage of the digestive pathway may necessitate gastrostomy.

Common gastrointestinal causes

• Esophageal strictures due to GERD or scarring
• Achalasia, where the esophagus fails to move food into the stomach
• Tumors obstructing the esophagus
• Severe Zenker’s diverticulum

If swallowing becomes impossible or unsafe, a gastrostomy tube allows nutrition to bypass the obstruction.

6. Prolonged Need for Nutritional Support :- Some patients are medically stable but unable to eat adequately for extended periods due to other health issues.

Situations requiring long-term nutritional support

• Prolonged hospitalization in ICU
• Severe burns or trauma increasing metabolic needs
• Chronic illnesses leading to significant weight loss
• Post-operative recovery following major abdominal or chest surgeries

Gastrostomy provides a reliable and long-term feeding route during recovery.

7. Severe Malnutrition or Failure to Thrive :- In both children and adults, failure to thrive or severe malnutrition may prompt the need for gastrostomy when oral feeding cannot meet nutritional requirements.

Common scenarios include

• Chronic illness limiting appetite
• Developmental disorders affecting feeding skills
• Conditions causing frequent vomiting or poor absorption
• Extremely low body weight impacting health

A gastrostomy tube ensures stable nutrient intake, helping the body regain strength and achieve healthy weight gain.

8. Need for Gastric Decompression :- In certain gastrointestinal or metabolic conditions, a gastrostomy tube is used not for feeding but to relieve pressure inside the stomach.

Conditions requiring decompressive gastrostomy include

• Severe gastroparesis (delayed stomach emptying)
• Bowel obstruction
• Chronic abdominal distension
• Conditions causing excessive air swallowing (aerophagia)

Decompression helps reduce nausea, vomiting, and bloating, improving overall comfort.

Conclusion

Gastrostomy is a life-supporting procedure recommended for a wide range of medical conditions affecting swallowing, digestion, or nutritional intake. Whether caused by neurological disorders, congenital abnormalities, cancers, or chronic illnesses, the primary goal is to ensure safe, reliable, and adequate nutrition.