Why does my mother spit oral feed?

Question

Hi doctor,

My mom has had issues with eating. She has a PEG tube, which was placed for this reason. She does not vomit the tube feeding, but she spits back up what she takes orally. Whatever food she takes, it comes back and is full of phlegm. She is an end stage COPD patient and BiPAP dependent. When she had her PEG tube placed, there were no strictures or any anatomical abnormality. She did have a yeast infection at that time, which was treated with IV Diflucan. She seemed to get better and was good for a month. Then, contracted C-diff colitis, which has now led to this situation. What can be causing the problem?

Answer 1

Hello,

Welcome to icliniq.com.

As per your mother's history, there are two different infections. They are Clostridium difficile infection and yeast infection.

The site of yeast infection is not mentioned in the question, though esophageal yeast infection is common.

C.difficile colitis can never be an indication for PEG tube (percutaneous endoscopic gastrostomy). This infection develops in the colon only when the normal bacterial flora of intestine gets destroyed by long term use of antibiotics.

Regurgitation of oral feed, but tolerance for PEG feed indicates some obstruction before PEG tube introduction that is an obstruction in the esophagus or at the junction of esophagus and stomach.

Also, BiPAP dependency (bilevel positive airway pressure) will not allow her to take feeding orally and this may be an indication for PEG tube feeding.

Development of yeast infection plus prolong use of antibiotics suggest that patient's immunity has reduced and therefore, she is vulnerable to other opportunistic infections. For her, to get chest infection might be easy.

In the absence of any abnormality of upper alimentary tract, presence of PEG tube feeding and regurgitation of oral feed are not a major concern.

It can be corrected with avoiding oral feed and keeping PEG tube for continuous drainage instead of blocked when she feel symptoms of vomiting or upper abdomen bloating.

For further information consult a medical gastroenterologist online.