Navigation Links
Gastric feeding tubes may raise pressure ulcer risk
Date:5/14/2012

PROVIDENCE, R.I. [Brown University] A new study led by Brown University researchers reports that percutaneous endoscopic gastric (PEG) feeding tubes, long assumed to help bedridden dementia patients stave off or overcome pressure ulcers, may instead make the horrible sores more likely to develop or not improve.

The analysis of thousands of nursing home patients with advanced dementia appears in the May 14 edition of the Archives of Internal Medicine.

"This study provides new information about the risks of feeding tube insertion in people with advanced cognitive impairment," said lead author Dr. Joan Teno, a gerontologist and professor of health services, policy, and practice in the Public Health Program at Brown. "We see a substantial risk of people developing a stage II and higher pressure ulcer. We believe these risks should be discussed with family members before a decision is made to insert a feeding tube in a hospitalized nursing home resident with advanced cognitive impairment."

In the new study, Teno and her team asked two basic questions: "How does having a gastric feeding tube affect the chances of preventing a stage II or greater pressure ulcer?" and "Does having a gastric feeding tube help heal an existing pressure ulcer?"

Previous studies, which were much smaller in scope, had produced inconclusive findings. By using a combination of federally gathered data from nursing homes and Medicare claims, the researchers essentially mimicked a randomized controlled trial through the use of "propensity match cohort" study. Over a particular timeframe, they compared thousands of patients with and without ulcers who received a feeding tube to three times as many statistically similar patients with and without ulcers who did not get a tube.

The risk of feeding tubes

What they found was that among patients who did not start with an ulcer, 35.6 percent of those with a feeding tube ended up with at least a stage II ulcer, while only 19.8 percent of patients without a feeding tube did. After statistical adjustment, they found that the chance of getting an ulcer was 2.27 times higher for people with feeding tubes than for those without. The risk of developing a more serious stage IV ulcer was 3.21 times higher for those with feeding tubes compared to hospitalized nursing home residents without a feeding tube.

Meanwhile, among patients who already had an ulcer, the researchers found that 27.1 percent of patients with a feeding tube saw short-term improvement, but 34.6 percent of those without a feeding tube experienced healing in a comparable timeframe. The adjusted odds of an ulcer getting better for people with a tube were 0.7 times as high for people without a tube, meaning their chances for improvement with a tube were less than for people without a tube.

The conventional wisdom among physicians three-quarters of them according to one study is that if anything, the nutrition delivered by feeding tubes should help patients resist ulcers. Perhaps with the idea of such a benefit in mind, physicians frequently don't discuss the risks of feeding tubes with patients' families, Teno has found.

The study did not measure how feeding tubes could cause ulcers, but Teno and her co-authors posit that because many patients become agitated by having a tube, they are often physically restrained and sedated with drugs. At the same time, feeding tubes can also increase the incidence of diarrhea. These circumstances, she said, may account for the development and worsening of pressure ulcers.

The new findings should lead doctors and families to ask more questions about whether feeding tubes are appropriate treatments, compared to careful hand feeding, for patients who have become so cognitively impaired that they can no longer eat independently, Teno said.

"To me this article is a game changer," Teno said. "It provides solid evidence that there is a risk and that we need to discuss it. I'm hoping that people now can use this study to make better decisions in light of a patient's goals and values."


'/>"/>

Contact: David Orenstein
david_orenstein@brown.edu
401-863-1862
Brown University
Source:Eurekalert  

Related medicine news :

1. Gastric Banding Most Effective for Obese Teens
2. Herceptin and Tykerb effective against a subset of gastric cancers
3. Roche/Genentech/Chugais Herceptin as an Add-On to Standard Chemotherapy Will Become Decision Resources Clinical Gold Standard in 2013 for the Treatment Of Gastric Cancer
4. Gastric bypass surgery increases risk of kidney stones
5. Dr. Feiz (drfeiz.com) Asks: What Is Better for You? Lap Band Surgery/Realize Band Surgery or Gastric Bypass Surgery
6. Promising hormone may help reduce malnutrition in gastric cancer patients
7. Houston Weight-Loss Surgical Specialists Offer Gastric Sleeve Operation For $11K
8. X-Ray Can Spot Gastric Band Slippage
9. New study identifies potential vaccine to prevent gastritis, ulcer disease, gastric cancer
10. Gastric Bypass Best for Weight Loss, Study Finds
11. Urinary metabolomic profile and gastric cancer
Post Your Comments:
*Name:
*Comment:
*Email:
Related Image:
Gastric feeding tubes may raise pressure ulcer risk
(Date:10/13/2017)... ... 2017 , ... The Visiting Nurse Association (VNA) of Somerset Hills is proud ... and unique items from across the nation, this holiday-themed event will raise funds and ... the VNA. The boutique will be open Saturday, November 4 (10:00 a.m. – ...
(Date:10/13/2017)... ... October 13, 2017 , ... Yisrayl Hawkins, Pastor and Overseer at The House ... most popular and least understood books in the Holy Scriptures, Revelation. The Book of ... baffled scholars for centuries. Many have tossed it off as mere rubbish, but Yisrayl ...
(Date:10/13/2017)... ... ... Journey: From the Mountains to the Mission Field”: the story of a missionary couple ... From the Mountains to the Mission Field” is the creation of published author, Carole ... and currently teaches a class of ladies at her church, which she has taught ...
(Date:10/12/2017)... ... October 12, 2017 , ... ... sleep apnea using cutting-edge Oventus O2Vent technology. As many as 18 ... characterized by frequent cessation in breathing. Oral appliances can offer significant relief to ...
(Date:10/12/2017)... ... October 12, 2017 , ... IsoComforter, Inc. ( ... today the introduction of an innovative new design of the shoulder pad. The ... get maximum comfort while controlling your pain while using cold therapy. By utilizing ice ...
Breaking Medicine News(10 mins):
(Date:10/10/2017)... 10, 2017   West Pharmaceutical Services, Inc. ... injectable drug administration, today shared the results of a ... improving the intradermal administration of polio vaccines. The study ... in May 2017 by Dr. Ondrej Mach , ... Health Organization (WHO), and recently published in the journal ...
(Date:10/4/2017)... Mass. , Oct. 4, 2017  According to the Centers for ... the end of October . PhysicianOne Urgent Care is helping communities across ... Westchester, NY , by offering no-cost* flu shots through the ... as mandated by certain health insurance regulations. ... The best time to get a flu shot is by the ...
(Date:10/2/2017)... 2017  AllianceRx Walgreens Prime, the combined central specialty ... pharmacy benefit manager Prime Therapeutics LLC (Prime), today officially ... the unveiling of new signage at its headquarters in ... at a few other company-owned facilities across the country. ... some of whom will begin to see the AllianceRx ...
Breaking Medicine Technology: