Gastric ulcer hidden beneath a PEG tube bumper.

Hidden Danger: How a PEG Tube Can Cause Gastric Ulcers

Avery Sinclair in Health & Wellness December 2025 • 3 min read.

"A Case Study and What You Need to Know About Percutaneous Endoscopic Gastrostomy"

Percutaneous endoscopic gastrostomy (PEG) tubes are commonly used to provide nutrition for patients who have difficulty swallowing or eating. While generally safe, complications can occur. A recent case study highlights a rare but important complication: gastric ulcers hidden beneath the internal PEG bumper.

An 83-year-old male with Alzheimer's disease was admitted to a hospital with melena (dark, tarry stools indicating internal bleeding). He had a PEG tube placed three weeks prior due to aspiration pneumonia and wasn't taking gastrotoxic medications. His hematocrit level was low, indicating blood loss.

An esophagogastroduodenoscopy (EGD) was performed, revealing no active bleeding but a hyperemic (inflamed) area near the internal PEG bumper. Further investigation revealed a gastric ulcer with a visible vessel underneath the bumper, which was treated with endoscopic injection therapy and proton pump inhibitors.

The Hidden Threat: How PEG Tubes Cause Gastric Ulcers

Gastric ulcer hidden beneath a PEG tube bumper.

Gastric ulcers after PEG tube placement can arise from various factors. One potential cause is the pressure exerted by the internal PEG bumper on the stomach lining. This pressure can lead to mucosal ischemia (reduced blood flow) and subsequent ulcer formation.

In the case study, the ulcer was located on the posterior wall of the gastric body, where the PEG tube tip was attached. This location aligns with previous research that found gastric ulcers in this area in nine out of 92 patients with PEG tubes.

Puncture of a blood vessel during the procedure.
Traumatic erosions of the esophageal or gastric mucosa.
Reflux esophagitis.
Gastric ulcer.

This case underscores the importance of considering gastric ulcers as a potential cause of upper gastrointestinal bleeding in patients with PEG tubes. While reflux esophagitis is a more common cause, gastric ulcers should not be overlooked.

Prevention and Management: Protecting Patients with PEG Tubes

This case study offers several important lessons for preventing and managing gastric ulcers associated with PEG tubes:

Loosening a tight internal PEG bumper and keeping it away from the gastric mucosa for several weeks can promote ulcer healing. Additionally, when initially placing the PEG tube, avoid excessive pressure on the stomach lining to minimize the risk of ulcer development.

By remaining vigilant and implementing these strategies, healthcare providers can minimize the risk of gastric ulcers and ensure the safety and well-being of patients receiving PEG tube feeding.

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Everything You Need To Know

How does a PEG tube potentially cause gastric ulcers?

A Percutaneous Endoscopic Gastrostomy, or PEG tube, can lead to gastric ulcers due to the internal PEG bumper applying pressure on the stomach lining. This pressure can reduce blood flow, a condition known as mucosal ischemia, which then leads to ulcer formation. The case study showed the gastric ulcer was located where the PEG tube tip was attached, specifically on the posterior wall of the gastric body.

Can you describe the patient case that illustrated gastric ulcers forming after a PEG tube placement?

The case study featured an 83-year-old male with Alzheimer's disease who was admitted to the hospital with melena. He had a PEG tube placed three weeks prior due to aspiration pneumonia. The Esophagogastroduodenoscopy (EGD) revealed a gastric ulcer with a visible vessel underneath the bumper. This was addressed with endoscopic injection therapy and proton pump inhibitors.

Besides gastric ulcers, what other complications might arise from a PEG tube?

Besides gastric ulcers caused by pressure from the internal PEG bumper, other potential complications from a Percutaneous Endoscopic Gastrostomy include the puncture of a blood vessel during the procedure, traumatic erosions of the esophageal or gastric mucosa, and reflux esophagitis. It's important to differentiate these from gastric ulcers to provide appropriate treatment.

If someone with a PEG tube has upper gastrointestinal bleeding, what possible causes should doctors investigate?

When a patient with a Percutaneous Endoscopic Gastrostomy presents with upper gastrointestinal bleeding, both reflux esophagitis and gastric ulcers should be considered. While reflux esophagitis is more common, the possibility of gastric ulcers, especially those induced by the internal PEG bumper, should not be overlooked. Diagnostic procedures like an Esophagogastroduodenoscopy (EGD) can help determine the exact cause.

What important lessons can be learned about preventing and managing gastric ulcers related to PEG tubes?

The case study highlights the importance of considering gastric ulcers as a potential complication of Percutaneous Endoscopic Gastrostomy. Routine monitoring and prompt investigation of symptoms like melena are crucial. While not detailed, preventive measures might involve adjusting the PEG tube's placement or tension to minimize pressure on the gastric lining. Proton pump inhibitors play a vital role in managing gastric ulcers once they develop, as demonstrated in the case study.