Granulation tissue around a gastrostomy tube is an overgrowth of moist, red, bumpy tissue at the stoma site, and it’s one of the most common complications of having a G-tube. It forms because the body treats the tube as a foreign object and mounts a prolonged inflammatory response that never fully transitions into normal healing. Understanding the specific triggers helps you take practical steps to reduce flare-ups.
Why the Stoma Never Fully Heals
Normal wound healing moves through predictable stages: inflammation, tissue rebuilding, and maturation. A G-tube disrupts that process because the tube sits permanently in the wound. The body’s immune system continuously sends inflammatory cells, new blood vessels, and structural proteins (the building blocks of scar tissue) to the area, trying to wall off what it perceives as a foreign invader. Instead of completing the healing cycle, the stoma gets stuck in the rebuilding phase, producing excess tissue that rises above the skin surface.
This tissue looks pink to dark red, feels puffy or bubbly, appears wet or shiny, and bleeds easily when bumped. It can be painful, but it does not spread outward the way an infection does. It’s also worth knowing that granulation tissue tends to worsen during unrelated illnesses like respiratory infections or stomach bugs, likely because the body’s overall inflammatory load increases.
Tube Movement and Friction
The single biggest controllable trigger is how much the tube moves at the skin surface. Every time the tube shifts, it irritates the lining of the stoma tract, restarting the inflammatory cycle. Poor positioning of the external fixation plate, a tube that’s too long, or a child who is active and pulls at the device all increase friction at the wound interface.
Switching to a low-profile button device can help if the current tube has excess length outside the body. The key is that the device fits snugly in the tract with minimal in-and-out or side-to-side movement. Securing the tube properly and checking the external fixator’s position at each feeding are straightforward ways to reduce mechanical irritation.
Moisture and Gastric Acid Leakage
A stoma that stays wet is a stoma that stays inflamed. Gastric fluid is highly acidic, and even small amounts leaking around the tube break down the surrounding skin, stripping away its natural protective barrier. The skin’s normal pH sits between 4.0 and 5.9. Gastric juice is far more acidic than that, and the digestive enzymes it contains actively damage exposed tissue. Chronic leakage leads to skin breakdown (maceration), which the body then tries to repair with more granulation tissue, creating a frustrating cycle.
Leakage often signals that the tube diameter is too small for the tract, that the balloon is underinflated, or that the tube has shifted out of position. Keeping the skin around the stoma clean and dry, and addressing the underlying cause of any leakage, reduces the moisture-driven irritation that fuels tissue overgrowth.
Bacterial Biofilm on the Tube
Every silicone G-tube eventually develops a biofilm, a thin layer of bacteria that adheres to the tube’s surface and resists normal cleaning. A study that examined 18 silicone gastrostomy devices found biofilm growth on all of them. The most common bacteria identified were Bacillus, Enterococcus, and Staphylococcus species.
This biofilm sustains a low-grade infection that keeps inflammatory cells flooding the stoma site. It doesn’t always cause the obvious redness, warmth, and pus you’d associate with a full-blown skin infection, but it provides a constant stimulus that tips the healing process toward overgranulation. Regular tube changes on the recommended schedule help reset the biofilm clock, and recognizing the difference between biofilm-driven granulation and true cellulitis (which spreads outward with increasing redness, swelling, and fever) matters for choosing the right response.
Retained Suture Material
In some cases, granulation tissue forms as a direct immune reaction to leftover sutures at the stoma site. These small granulomas appear as red, moist, tender bumps right at the junction where skin meets the stoma lining. They weep clear fluid, which adds to the moisture problem and can interfere with dressing adhesion. If suture fragments are found, removing them often resolves the granulation quickly.
What Granulation Tissue Looks Like vs. Infection
It’s easy to confuse the two, but granulation tissue and stoma infection have distinct features. Granulation tissue is pink to dark red, bubbly, shiny, and bleeds easily. It stays localized right at the stoma edge. An infection, by contrast, spreads into the surrounding skin with expanding redness, warmth, swelling, and sometimes fever or pus with an odor. Both can be painful, but the spreading pattern is what separates them. Granulation tissue is an overzealous healing response, not an active bacterial invasion of the skin, though biofilm on the tube can contribute to both problems.
Common Treatments
Most granulation tissue responds to topical treatments without surgery. The two most widely used approaches are chemical cauterization and prescription creams.
- Silver nitrate: Applied directly to the granulation tissue using a stick or solution-dipped applicator, typically two to three times per week for two to three weeks. It chemically burns away the excess tissue. It should only touch the granulation tissue itself, because it can damage healthy surrounding skin.
- Topical steroid cream: Applied to the granulation tissue (not the healthy skin around it) to reduce inflammation. A common approach is using the cream for two weeks, taking a one-week break, and then repeating for another two weeks if the tissue persists.
Neither treatment works well if the underlying cause, whether it’s friction, moisture, or biofilm, isn’t also addressed. Treating the tissue without stabilizing the tube or managing leakage typically results in the granulation coming right back.
Dressings That Help Prevent Recurrence
Foam and hydrocolloid dressings placed around the tube at the stoma site can reduce granulation tissue by absorbing moisture and cushioning the skin against friction. Clinical trials have tested plain foam, silver-impregnated foam, and hydrocolloid dressings applied around the tube and changed every other day for the first 30 days after placement. The idea is that controlling moisture and minimizing mechanical irritation during the critical early healing window gives the stoma a better chance of progressing through normal repair rather than getting stuck in the inflammatory phase.
For an established stoma that keeps producing granulation tissue, using a thin barrier dressing between the external fixator and the skin can serve the same purpose: absorbing leaked fluid and reducing the repetitive rubbing that restarts inflammation with every movement.
When Topical Treatments Aren’t Enough
A small number of cases don’t respond to silver nitrate, steroid creams, or improved tube care. For these medically refractory situations, surgical options exist. The tube may be removed and re-placed at a new site, or a wedge resection (cutting out the overgrown tissue at the stoma) can be performed to give the site a fresh start. These interventions are reserved for persistent problems that have failed standard management over weeks to months, particularly when the granulation tissue causes significant pain, bleeding, or interferes with tube function.