Granulation tissue is a hot topic when feeding tubes are concerned.  Some people are prone to it, some never get it, and everyone wants to know how to get rid of it now!

What is granulation tissue?

Granulation tissue is actually new tissue and microscopic blood vessels that forms around a wound when it is healing.  In this case, the wound is around a feeding tube like G tube, GJ tube, or separate J tube. Typically granulation tissue starts at the base of the “wound” and will grow to fill the wound up to any size. It can look lumpy and bumpy and usually light pink to red in color.  It is normally soft and wet to the touch. Healthy granulation tissue is usually painless.  

What causes granulation tissue around a g tube?

Now the reason why granulation tissue and gtubes are problematic, is because a g tube is not a “wound” that you want to fully heal.  The stoma actually needs to stay open to some degree so the feeding tube stays in place.  

The major causes of granulation or hypergranulation (excessive granulation tissue) are:

• a super wet stoma site (excessive leaking around the feeding tube
• the feeding tube moves around a lot (this can indicate a wrong size)
•  too much pressure directly on the stoma (if sizing is too tight)
• caused by trauma to the site like pulling or tugging on the button or extensions.

G Tube site irritation vs Granulation tissue

A g tube site irritation is typically on the skin surrounding the site and can extend further out a few inches.  This is typically pink or red and caused by trauma, acid reflux, leaking, or a yeast infection.  Granulation tissue is very confined to the actual stoma of the feeding tube.  It kind of looks like extra tissue trying to escape the hole of the stoma.

Granulation tissue vs Gastric Prolapse

Granulation tissue is part of the healing process of a wound, whereas gastric prolapse of a feeding tube is when the tube is no longer secured to the stomach.  This may cause a hernia and part of the stomach will actually start to be pushed out through the stoma.  Gastric prolapse of a feeding tube is actually very rare.

Is granulation tissue bad?

Granulation tissue is not actually bad, but it can cause some pain and discomfort.  Granulation has the tendency to bleed easily because it is made up of blood vessels.  Every time the tissue is bumped or pulled, it will start to bleed and may be painful.  A little tiny bit of granulation tissue can just be a nuisance, but hypergranulation (excessive amounts of granulation tissue) can make the site very painful and cause extra leaking.  Depending on how the tissue grows, it may lead the button to be off center of leaning to one side and this can cause leaking of stomach acids and be very painful.  Granulation tissue is actually a good thing, because it is part of healing!

Is granulation tissue around a g tube caused by an infection?

No, granulation tissue is not caused by an infection, but you may notice it starts to grow during an infection.  When you body is fighting an infection your white blood cells are in fight mode and trying to get rid of any foreign bodies or harmful infections.  So sometimes these white blood cells get a little too excited and start trying to heal the stoma, which is when granulation tissue starts to form.

How to get rid of and treat granulation tissue around a g tube?

There are many common treatments for granulation tissue.  These are typically done in an office with your medical team.  The most common are:

• silver nitrate treatment – this burns away the excess tissue and promotes the area to heal.  Tissue is usually gone immediately.
• silver dressings- these are gauze infused with silver and it is similar to a silver nitrate treatment, except instead of taking a day to remove the excessive tissue, this may take a week or two.
• .5 -1.0% hydrocortisone cream- this is typically a prescription written by a doctor.  The cream is a short term solution, and should only be used for 1 week. 
• topical corticosteroid- another cream with steroids in it to help promote healing to the area and this will normally require a prescription.

Home Remedies for Granulation Tissue

Many home remedies have become available to treat granulation tissue at home.  I do recommend that you discuss these options with your doctor first, because any treatment may have interactions with medicines.

1. Hypertonic Salt Water Soak– Take a mixture of 2 teaspoons table salt with 1 cup of water and mix until dissolved. Soak a split gauze in this mixture and wring out the excess moisture so it is not soaking wet. Place the moist split gauze around the feeding tube site for 5 to 10 minutes.  You do not want the gauze to dry because it may be painful to remove if it dries to the stoma/granulation tissue.  This is similar to a epsom salt soak in the tub, but very direct to just the feeding tube site.  It is recommended to do this 4 times a day.
2. Tape down the button and extensions– if your granulation tissue is formed due to friction of irritation because the button and extensions keep getting pulled or moving around, try taping it down.  Personally I like to use paper tape, because it is great for sensitive skin.  You can tape the button down with gauze in a tic tac toe manner (2 strips vertically and 2 strips horizontally).  It is best to use adhesive remover to remove the tape so it doesn’t cause further irritation when the tape is removed by being pulled.
3. Calmoseptine Ointment-  This cream can be found in a pharmacy or on amazon, and it is similar to a skin protectant and barrier cream.
4. GranuLotion– this is more natural alternative to steroids and silver nitrate.  According to their website,  it is made with aloe, tea tree oil, licorice extract to reduce itching and naturally clean the site.  It also has zinc and vitamin E to act as a skin barrier and promote improvement to the site. The lotion is said to make the granulation tissue shrivel up and collapse and leaving the site clear and dry.
5. Aquafor & table salt-  Similar to the hypertonic soak, this one makes a paste of aquafor and table salt and you rub this mixture around the site.
6. Desitin Diaper Rash Cream– this one is used more as a skin protectant and in theory if your use it on the granulation tissue and it stops being so wet, it will shrink back down.
7. Alum Spice Powder– This is typically found in the spice aisle of the grocery store and you can mix it with calmoseptine ointment, aquarfor, or desitin until it forms a paste.  You spread this around the feeding tube site, and it takes a few days to make the tissue dry out and go back down.
8. Ciprodex drops– these are actually made for ear infections, but they work by drying out the tissue just like it dries out moisture inside the ear.  A few drops a day for a few days and the tissue shrinks back.

Can granulation tissue around a g tube keep coming back?

Yes! Unfortunately if the main cause of granulation tissue is not fixed like excessive leaking or irritation from being pulled, the tissue will keep forming.  It is a cycle where it will get bad, you will treat it, and after a while, it will come back.  It is your body trying to fix where it thinks there is a problem.  If you can keep the site dry and without irritation/trauma, the site should stay granulation free!