1. Nutrition for Patients with Upper Gastrointestinal Disorders Chapter 17

2. 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. 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. 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. Disorders That Affect Eating—(cont.) 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 oPyloric or intestinal obstruction

6. Disorders That Affect Eating—(cont.) Nausea and vomiting—(cont.) –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 commonsense 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. Disorders That Affect Eating—(cont.) Nausea and vomiting—(cont.) –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. 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 disease, and multiple sclerosis.

9. Disorders of the Esophagus—(cont.) Dysphagia—(cont.) –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.

10. Disorders of the Esophagus—(cont.) Dysphagia—(cont.) –Nutrition therapy—(cont.) oSpeech or language pathologist (SLP) performs a swallowing evaluation. oRecommends feeding techniques based on the patient’s individual status oMoist, semisolid foods are easiest to swallow. oCommercial 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. Disorders of the Esophagus—(cont.) Dysphagia—(cont.) –Nutrition therapy—(cont.) oThickened liquids are more cohesive than thin liquids and are easier to control.  Often poorly accepted oVarious feeding techniques may facilitate safe swallowing.

12. 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. Gastroesophageal Reflux Disease—(cont.) Gastroesophageal reflux disease (GERD)— (cont.) –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. Gastroesophageal Reflux Disease—(cont.) Nutrition therapy –A three-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. Gastroesophageal Reflux Disease—(cont.) Nutrition therapy—(cont.) –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 antireflux medications.

16. Disorders of the Stomach Peptic ulcer disease –H. pylori infection –Second leading cause of peptic ulcers is the use of nonsteroidal anti-inflammatory drugs. –Pain from duodenal ulcers may be relieved by food. –Pain from gastric ulcers may be aggravated by eating.

17. Disorders of the Stomach—(cont.) Peptic ulcer disease—(cont.) –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. Disorders of the Stomach—(cont.) Peptic ulcer disease—(cont.) –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. Disorders of the Stomach—(cont.) Peptic ulcer disease—(cont.) –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. Disorders of the Stomach—(cont.) 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. Disorders of the Stomach—(cont.) Dumping syndrome—(cont.) –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. Disorders of the Stomach—(cont.) Dumping syndrome—(cont.) –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. Disorders of the Stomach—(cont.) Dumping syndrome—(cont.) –Late—(cont.) 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. Disorders of the Stomach—(cont.) Dumping syndrome—(cont.) –Increased risk of maldigestion, malabsorption, and decreased oral intake –Excretion of calories and nutrients produces weight loss and increases the risk of malnutrition.

25. Disorders of the Stomach—(cont.) Dumping syndrome—(cont.) –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.