1. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrition for Patients with Upper Gastrointestinal Disorders Chapter 17

2. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Nutrition for Patients With Gastrointestinal Disorders Nutrition therapy is used in the treatment of many digestive system disorders –Some diet therapy is only supportive –Some diet therapy is cornerstone of treatment

3. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders That Affect Eating Anorexia –Common symptom of many physical conditions –Side effect of certain drugs –Emotional issues –Aim of nutrition therapy is to stimulate the appetite to maintain adequate nutritional intake

4. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Interventions That May Help Anorexia Serve food attractively and season it according to individual taste Schedule procedures and medications when they are least likely to interfere with meals, if possible Control pain, nausea, or depression with medications as ordered Provide small frequent meals Withhold beverages for 30 minutes before and after meals Offer liquid supplements between meals Limit fat intake if fat is contributing to early satiety

5. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders That Affect Eating (cont’d) Nausea and vomiting –May be related to: oA decrease in gastric acid secretion oA decrease in digestive enzyme activity oA decrease in gastrointestinal motility, gastric irritation, or acidosis oBacterial and viral infection, increased intracranial pressure, equilibrium imbalance oLiver, pancreatic, and gallbladder disorders; and pyloric or intestinal obstruction

6. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders That Affect Eating (cont’d) Nausea and vomiting (cont’d) –Short-term concern of nausea and vomiting is fluid and electrolyte balance –With intractable or prolonged vomiting, dehydration and weight loss are concerns –Nutrition intervention for nausea is a common-sense approach oFood is withheld until nausea subsides oClear liquids are offered and progressed to a regular diet as tolerated oSmall meals of easily digested carbohydrates

7. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders That Affect Eating (cont’d) Nausea and vomiting (cont’d) –Interventions that might help oEncourage the patient to eat slowly and not to eat if he or she feels nauseated oPromote good oral hygiene with mouthwash and ice chips oLimit liquids with meals oServe foods at room temperature or chilled oAvoid high-fat and spicy foods if they contribute to nausea

8. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Esophagus Symptoms range from difficulty swallowing and the sensation that something is stuck in the throat to heartburn and reflux Dysphagia –Impairments in swallowing can have a profound impact on intake and nutritional status –Mechanical causes include obstruction, inflammation, edema, and surgery of the throat –Neurologic causes include amyotrophic lateral sclerosis (ALS), myasthenia gravis, cerebrovascular accident, traumatic brain injury, cerebral palsy, Parkinson’s disease, and multiple sclerosis

9. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Esophagus (cont’d) Dysphagia (cont’d) –Nutrition therapy oGoal is to modify the texture of foods and/or viscosity of liquids to enable the patient to achieve adequate nutrition and hydration while decreasing the risk of aspiration oEmotionally, dysphagia can affect quality of life oNational Dysphagia Diet

10. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Esophagus (cont’d) Nutrition therapy (cont’d) –Speech or language pathologist (SLP) performs a swallowing evaluation –Recommends feeding techniques based on the patient’s individual status –Moist, semisolid foods are easiest to swallow –Commercial thickeners added to pureed foods can allow pureed foods to be molded into the appearance of “normal” food, which is more visually appealing than “baby food”

11. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Esophagus (cont’d) Nutrition therapy (cont’d) –Thickened liquids are more cohesive than thin liquids and are easier to control oOften poorly accepted –Various feeding techniques may facilitate safe swallowing

12. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Gastroesophageal Reflux Disease Gastroesophageal reflux disease (GERD) –Caused by an abnormal reflux of gastric contents into the esophagus related to an abnormal relaxation of the lower esophageal sphincter –Other contributing factors oIncreased intra-abdominal pressure oDecreased esophageal motility –Indigestion, “heartburn,” and regurgitation are common

13. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Gastroesophageal Reflux Disease (cont’d) Gastroesophageal reflux disease (GERD) (cont’d) –Pain frequently worsens when the person lies down, bends over after eating, or wears tight-fitting clothing –Chronic untreated GERD may cause reflux esophagitis, dysphagia, adenocarcinoma, esophageal ulcers, and bleeding

14. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Gastroesophageal Reflux Disease (cont’d) Nutrition therapy –A 3-pronged approach is used to treat GERD oLifestyle modification, including nutrition therapy oDrug therapy oSurgical intervention, if necessary –Lifestyle and diet modifications focus on reducing or eliminating behaviors believed to contribute to GERD

15. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Gastroesophageal Reflux Disease (cont’d) Nutrition therapy (cont’d) –Elevate the head of the bed 6 to 8 inches and avoid lying down for 3 hours after meals to limit esophageal acid exposure –Avoid alcohol –Avoid spicy food –Limit fat intake –Limit caffeine, chocolate, and peppermint –Take anti-reflux medications

16. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach Peptic ulcer disease –Approximately 15% of ulcers occur in the stomach and the remaining 85% are in the duodenum –H. pylori infection –Second leading cause of peptic ulcers is the use of nonsteroidal antiinflammatory drugs –Pain from duodenal ulcers may be relieved by food –Pain from gastric ulcers may be aggravated by eating

17. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Peptic ulcer disease (cont’d) –After nausea and vomiting subside, low-fat carbohydrate foods, such as crackers, toast, oatmeal, and bland fruit, usually are well tolerated –Patients should avoid liquids with meals because liquids can promote the feeling of fullness –Pain, food intolerances, or loss of appetite may impair intake and lead to weight loss –Iron-deficiency anemia can develop from blood loss

18. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Peptic ulcer disease (cont’d) –No evidence that diet causes peptic ulcer disease or speeds ulcer healing –Some evidence suggests that a high-fiber diet, especially soluble fiber, may reduce the risk of duodenal ulcer –Nutrition intervention may play a supportive role in treatment by helping to control symptoms

19. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Peptic ulcer disease (cont’d) –Strategies that may help oAvoid foods that stimulate gastric acid secretion, namely coffee (decaffeinated and regular), alcohol, and pepper oAvoid eating 2 hours before bed oAvoid individual intolerances

20. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Dumping syndrome –Common complication of gastrectomy and gastric bypass is dumping syndrome –Group of symptoms caused by rapid emptying of stomach contents into the intestine

21. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Dumping syndrome (cont’d) –Early oLarge volume of hypertonic fluid into the jejunum and an increase in peristalsis leads to nausea, vomiting, diarrhea, and abdominal pain oWeakness, dizziness, and a rapid heartbeat occur as the volume of circulating blood decreases oThese symptoms occur within 10 to 20 minutes after eating

22. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Dumping syndrome (cont’d) –Intermediate oOccurs 20 to 30 minutes after eating oDigested food is fermented in the colon, producing gas, abdominal pain, cramping, and diarrhea –Late oOccurs 1 to 3 hours after eating

23. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Dumping syndrome (cont’d) –Late oRapid absorption of carbohydrate causes a quick spike in blood glucose levels oBody compensates by oversecreting insulin oBlood glucose levels drop rapidly oSymptoms of hypoglycemia develop, such as shakiness, sweating, confusion, and weakness

24. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Dumping syndrome (cont’d) –Increased risk of maldigestion, malabsorption, and decreased oral intake –Excretion of calories and nutrients produces weight loss and increases the risk of malnutrition

25. Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Disorders of the Stomach (cont’d) Dumping syndrome (cont’d) –Nutrition therapy oEat small, frequent meals oEat protein and fat at each meal oAvoid concentrated sugars oRestrict lactose oConsume liquids 1 hour before or after eating instead of with meals