J Tube Feeding

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Surgical Intervention
Jejunal feeding tubes       

A PEJ tube can be placed endoscopically by a gastroenterologist and is often an outpatient procedure. The procedure is performed by placing a tube down the patient’s esophagus, through the stomach, and into the first portion of the jejunum. When the doctor finds a good location, a light is shined through the skin and the incision is made. The tube is inserted and a hard bolus is placed on the inside of the intestines to keep the tube from coming out. 

A j-tube can be placed either laparoscopically or through an open procedure. Typically, it is placed laparoscopically unless the patient is not a candidate due to adhesions from previous surgeries or other complications. Usually after a surgical placement the patient will remain in the hospital at least for a few days as the nutrition is started very slowly until the patient is tolerating the feedings well enough to go home under the care of a home health care agency. Complications of the j-tube include pain, bowel obstruction, not tolerating feedings, and skin and internal infections. However, the complications are usually less serious than those associated with IV nutrition and therefore the j-tube is a good alternative for someone in need of longterm nutritional support.² 

Anti-Dumping Diet

Anti-dumping diet is for persons with partial to total gastrectomies (stomach partially or totally removed) or gastric bypass (part of the stomach is bypassed) for morbid obesity. They don't tolerate:

• tough meat, especially beef
   

• milk and dairy products
   

• bread, especially when fresh or fluffy can form a ball
   

• pasta
   

• cirtus juices and fruits
   

• fried foods
   

• concentrated sweets

Also drinking fluids with meals displaces nutrient dense foods and tends to make the person feel bloated even if flat (fizz gone) carbonated beverages are drank.

What happens is because of the smaller gastric pouch, the simple sugars aren't broken down prior to being dumped into the duodenual intestines. The sugars ferment and cause bloating or often vomiting. Nausea, vomiting, bloating or heartburn can also result from:

• eating or drinking too quickly,
   

• not chewing food adequately especially beef,
   

• eating high fiber foods that can block the stoma,
   

• drinking cold fluids,
   

• eating too much,
   

• drinking with a straw,
   

• eating rich or sweet foods,
   

• eating gas producing foods or drinking carbonated beverages,
   

• eating foods that usually cause gastric discomfort to the individual.

Nutritional adequacy may be lacking due to decreased volume of food in either gastrectomy or bypass. Consider vitamin or mineral supplements, but only if the intestines have not been surgically shortened. 

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