Nasojejunal feeding tubes (placed in the small intestine) help stroke patients recover better nutritionally than nasogastric tubes (placed in the stomach), according to a 2026 study of 322 stroke patients in China. Patients using nasojejunal tubes showed significantly greater improvements in blood iron and protein levels, but required longer hospital stays and higher costs. Gram Research analysis suggests doctors should choose tube type based on each patient’s individual needs, balancing nutritional recovery against financial constraints.
When stroke patients can’t eat normally, doctors use feeding tubes to deliver nutrition directly into the stomach or intestines. A new study from China compared two common types: nasogastric tubes (which go to the stomach) and nasojejunal tubes (which go deeper into the small intestine). Researchers found that nasojejunal tubes helped patients gain weight and recover better nutritionally, but cost more money. The study suggests doctors should choose based on each patient’s individual needs and financial situation, rather than using one approach for everyone.
Key Statistics
A 2026 retrospective study of 322 stroke patients in China found that nasojejunal feeding tubes produced significantly greater improvements in hemoglobin and albumin levels compared to nasogastric tubes, indicating better nutritional recovery.
Among 149 stroke patients analyzed for costs under China’s DRG payment system, those receiving nasojejunal tubes had higher hospitalization costs and greater risk of exceeding insurance reimbursement limits, despite superior nutritional outcomes.
In a propensity-matched analysis of 66 patient pairs, nasojejunal feeding was associated with better control of malnutrition and inflammatory markers in stroke patients, though at increased financial burden to hospitals.
The Quick Take
- What they studied: Whether feeding tubes placed in the stomach (nasogastric) or deeper in the small intestine (nasojejunal) work better for stroke patients who can’t eat normally
- Who participated: 322 stroke patients admitted to a major hospital in China between 2021 and 2024. About 60% received stomach tubes and 40% received intestinal tubes. The final cost analysis included 149 patients.
- Key finding: Nasojejunal tubes (intestinal placement) helped patients recover better nutritionally with greater improvements in blood protein and iron levels, but required longer hospital stays and higher costs
- What it means for you: If you or a loved one has a stroke and needs a feeding tube, the choice between stomach and intestinal placement should consider both recovery quality and cost. Talk with your doctor about which option fits your situation best.
The Research Details
Researchers looked back at medical records from 322 stroke patients who received feeding tubes between January 2021 and December 2024 at a major hospital in central China. They divided patients into two groups: 193 received nasogastric tubes (placed in the stomach) and 129 received nasojejunal tubes (placed in the small intestine). The researchers carefully matched patients in each group to make sure they were similar in age, severity of stroke, and other health factors.
To ensure their findings were reliable, they used a statistical technique called propensity score matching, which is like creating identical twins from each group to compare fairly. This reduced the final analysis to 66 pairs of patients—one from each tube type—who were nearly identical except for which feeding tube they received.
The researchers measured several important outcomes: how well patients’ nutrition improved (by checking blood iron and protein levels), what complications developed, how long patients stayed in the hospital, and how much the hospital bills exceeded what insurance would pay under the DRG system (a fixed payment method).
This research approach matters because it looks at real-world patient data rather than controlled lab conditions. By comparing patients who were as similar as possible, the researchers could fairly determine whether differences in outcomes came from the tube type itself, not from patients being sicker or healthier to begin with. The study also examined costs, which is important because hospitals operate under budget constraints.
This study has several strengths: it included a large number of patients (322), used careful statistical matching to ensure fair comparison, and examined both medical outcomes and financial data. However, it was conducted at a single hospital in China, so results may not apply equally to all populations. The study looked backward at existing records rather than randomly assigning patients to tube types, which means some differences could be due to factors doctors considered when choosing the tube type. The researchers were transparent about these limitations.
What the Results Show
Patients who received nasojejunal tubes (intestinal placement) showed significantly better nutritional recovery than those with nasogastric tubes (stomach placement). Specifically, the nasojejunal group had greater improvements in hemoglobin (the protein that carries oxygen in blood) and albumin (a key protein made by the liver). These improvements suggest that the intestinal tubes delivered nutrition more effectively to patients’ bodies.
The nasojejunal group also had lower rates of malnutrition and showed better control of inflammation markers—signs that their bodies were healing better. However, this came with a trade-off: patients with nasojejunal tubes stayed in the hospital longer and had higher total medical bills. More importantly, their hospital costs were more likely to exceed what insurance would reimburse under the DRG payment system, meaning the hospital lost money on these cases.
When researchers looked at the matched pairs of similar patients, the pattern held: nasojejunal tubes provided better nutritional benefits but at higher financial cost. The study found that nasojejunal feeding was associated with greater DRG cost overrun risk—meaning hospitals were more likely to lose money when using this approach.
The study also examined complication rates, though specific numbers weren’t emphasized in the abstract. The nasojejunal group started with lower baseline hemoglobin levels before treatment, suggesting they may have been in worse nutritional condition initially. Despite this disadvantage, they showed greater recovery, which strengthens the evidence that the tube placement itself made a difference. The research suggests that individual patient factors—such as initial nutritional status and ability to pay—should influence which tube type doctors choose.
According to Gram Research analysis, this study adds important economic data to existing medical knowledge about feeding tubes in stroke patients. Previous research has shown that nasojejunal tubes can reduce certain complications like aspiration (food entering the lungs), but this is one of the first studies to comprehensively compare both clinical outcomes and financial impact under a fixed-payment insurance system. The findings suggest that the ‘best’ tube type depends on whether the priority is maximum nutritional recovery or controlling hospital costs.
This study has several important limitations. First, it was conducted at a single hospital in China, so results may not apply to other countries with different healthcare systems or patient populations. Second, because researchers looked at existing medical records rather than randomly assigning patients to tube types, doctors may have chosen the tube type based on factors that also affected outcomes—for example, sicker patients might have received intestinal tubes. Although the researchers used statistical matching to address this, some bias may remain. Third, the study focused on short-term outcomes during hospitalization; we don’t know if the nutritional benefits of nasojejunal tubes lasted after patients went home. Finally, the economic analysis was specific to China’s DRG payment system and may not apply to other insurance systems.
The Bottom Line
For stroke patients who cannot eat normally and need feeding tubes, the choice between nasogastric (stomach) and nasojejunal (intestinal) placement should be individualized. If nutritional recovery is the top priority and the patient can afford longer hospitalization, nasojejunal tubes appear superior (moderate confidence based on this single-hospital study). If controlling costs is critical, nasogastric tubes may be preferable despite slightly lower nutritional gains (moderate confidence). Doctors should discuss both options with patients and families, considering the patient’s condition, financial situation, and recovery goals.
This research matters most for stroke patients who cannot swallow safely, their families, and their doctors. It’s particularly relevant for hospitals operating under fixed-payment insurance systems similar to China’s DRG model. Patients with severe malnutrition or poor nutritional status may benefit more from nasojejunal tubes. Those with limited financial resources or shorter expected hospital stays might be better served by nasogastric tubes. This research is less directly applicable to patients who can eat normally or who receive nutrition through other methods.
Nutritional improvements from feeding tubes typically appear within days to weeks, as shown by improvements in blood protein and iron levels in this study. However, full recovery from stroke takes weeks to months. Patients should not expect dramatic changes immediately but should see gradual improvement in nutritional markers and overall strength over the course of their hospital stay and recovery period.
Frequently Asked Questions
What’s the difference between nasogastric and nasojejunal feeding tubes?
Nasogastric tubes are placed through the nose into the stomach, while nasojejunal tubes go deeper into the small intestine. The intestinal placement (nasojejunal) delivers nutrition more directly to where the body absorbs it, resulting in better nutritional recovery in stroke patients, though at higher cost.
Do feeding tubes help stroke patients recover better?
Yes, feeding tubes provide essential nutrition when stroke patients cannot swallow safely. Research shows nasojejunal tubes produce greater improvements in blood protein and iron levels than nasogastric tubes, supporting better nutritional recovery and reducing malnutrition complications.
Which feeding tube costs less for stroke patients?
Nasogastric tubes (stomach placement) typically cost less and result in shorter hospital stays. Nasojejunal tubes (intestinal placement) cost more and increase the risk of hospital bills exceeding insurance reimbursement, though they provide superior nutritional benefits.
How long do stroke patients need feeding tubes?
Duration varies by individual recovery. This study examined hospital stays but didn’t specify long-term tube duration. Most stroke patients transition to eating by mouth within weeks to months as they recover swallowing ability, at which point the feeding tube can be removed.
Should all stroke patients get nasojejunal tubes for better nutrition?
Not necessarily. While nasojejunal tubes provide better nutritional recovery, the choice should consider individual factors including cost, hospital resources, and patient goals. Doctors recommend a risk-stratified approach, selecting tube type based on each patient’s specific situation rather than using one approach for everyone.
Want to Apply This Research?
- If using a feeding tube after stroke, track weekly measurements of hemoglobin and albumin levels (obtainable from blood tests). Record these values in the app along with the date and tube type used. This creates a personal record showing whether nutritional status is improving and helps you and your doctor evaluate whether the current feeding approach is working.
- Work with your healthcare team to monitor tolerance of the feeding tube (comfort level, any nausea or reflux) and report changes promptly. If using an app, log any feeding-related symptoms daily and share this information with your doctor at appointments. This helps your medical team adjust the feeding plan if needed and ensures you’re getting optimal nutrition.
- Create a long-term tracking system that includes monthly nutritional lab values, hospital readmission rates, and functional recovery milestones (such as returning to eating by mouth). Use the app to set reminders for lab work appointments and to record how you’re feeling overall. This ongoing data helps you and your doctor assess whether the feeding tube choice was appropriate and when it might be safe to transition to eating normally.
This research describes medical outcomes from a single hospital in China and should not replace professional medical advice. The choice between feeding tube types should be made in consultation with your healthcare team, who can evaluate your individual condition, medical history, and circumstances. Results may not apply equally to all populations or healthcare systems. If you or a loved one has had a stroke and needs a feeding tube, discuss all options with your doctor before making decisions. This article is for educational purposes and does not constitute medical advice.
This research translation is published by Gram Research, the science division of Gram, an AI-powered nutrition tracking app.