Feeding tube

A feeding tube or use of enteral nutrition is a way to manage certain severe gastrointestinal problems or to increase food intake in a small number of patients with severe ME/CFS.

Feeding tubes typically refer to use of a catheter (narrow tube) to deliver liquid nutrition directly into part of the gastrointestinal tract, eg the jejunum or stomach.

Total parenteral nutrition
Parenteral nutrition refers to nutrition delivered intravenously through a central line near the top of the chest. Total parenteral nutrition (TPN) is the use of patenteral nutritional to fulfill all dietary needs (without eating).

Theory
Feeding can take place when severe gastroparesis prevents food being digested quickly enough by placing a tube lower in the digestive tract.

NG tube
A nasogastric tube is a tube from the nose through the esophagus and into the stomach.

NJ tube
A nasojejunal tube goes from the nose through the esophagus and stomach, and then into the small intestine.

PEG tube
A percutaneous endoscopic gastrostomy (PEG) feeding tube goes directly into the stomach, bypassing the nose, mouth and esophagus. A gastrostomy (surgery) is needed to place it into the stomach.

PEJ tube
A jejunostomy surgery is needed to insert a percutaneous endoscopic jejunostomy (PEJ) or PEJ tube through the skin and directly into the small intestine, bypassing the nose, mouth, esophagus and stomach.

TPN
Total parenteral nutrition requires surgery to place an IV tube into a vein, bypassing the gastrointestinal tract entirely.

Evidence
No studies have investigated the effects of the feeding, it is typically a last resort.

Patients who have used feeding tubes for ME/CFS include:
 * Merryn Crofts
 * Lynn Gilderdale
 * Whitney Dafoe

News and articles

 * 2023, Exeter ME patient's hospital care changed after campaign - BBC News Devon
 * Alice Barrett, a young British woman with very severe ME/CFS was initially denied feeding through her NG-tube while in hospital because she was unable to sit upright enough for her NG tube to be at a 30 degree angle. The hospital only changed its policy to allow parents went public with the risk of Alice dying from starvation caused by the hospital's policy.


 * 2022, Girl, 11, using feeding tube to eat a year after Covid left her too weak to move - Daily Mirror

Notable studies

 * 2021, Life-Threatening Malnutrition in Very Severe ME/CFS - (Full text)
 * 2021, Extremely Severe ME/CFS—A Personal Account - (Full text)

Risks and safety
Feeding tubes carry varying degrees of risk, including risks of surgery, complications from incorrect placement, risk of infection, and risk of nutritional deficiencies or complications from the feed used.

Risks of not using a feeding tube are also expected to be taken into account, for example continuing severe and rapid weight loss, becoming too weak from lack of food to swallow food, and life-threatening malnutrition. Risks from a TPN are significantly more than from nasal feeding tubes.

Costs and availability
Generally these require hospital treatment to insert or check.

Learn more

 * Home enteral nutrition - Mayo Clinic
 * Total Parenteral Nutrition - MedlinePlus
 * About the Placement of Your PEG or PEJ Tube for Feeding - Memorial Sloan Kettering Cancer Center