• Nutrition for Patients with Upper Gastrointestinal Disorders
Chapter 17
• 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
– 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
• 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
• Disorders That Affect Eating (cont’d)
• Nausea and vomiting
– May be related to:
o A decrease in gastric acid secretion
o A decrease in digestive enzyme activity
o A decrease in gastrointestinal motility, gastric irritation, or acidosis
o Bacterial and viral infection, increased intracranial pressure, equilibrium imbalance
o Liver, pancreatic, and gallbladder disorders; and pyloric or intestinal obstruction
• 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
o Food is withheld until nausea subsides
o Clear liquids are offered and progressed to a regular diet as tolerated
o Small meals of easily digested carbohydrates
• Disorders That Affect Eating (cont’d)
• Nausea and vomiting (cont’d)
– Interventions that might help
o Encourage the patient to eat slowly and not to eat if he or she feels nauseated
o Promote good oral hygiene with mouthwash and ice chips
o Limit liquids with meals
o Serve foods at room temperature or chilled
o Avoid high-fat and spicy foods if they contribute to nausea
• 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
• Disorders of the Esophagus (cont’d)
• Dysphagia (cont’d)
– Nutrition therapy
o Goal 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
o Emotionally, dysphagia can affect quality of life
o National Dysphagia Diet
• 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”
• Disorders of the Esophagus (cont’d)
• Nutrition therapy (cont’d)
– Thickened liquids are more cohesive than thin liquids and are easier to control
o Often poorly accepted
– Various feeding techniques may facilitate safe swallowing
• 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
o Increased intra-abdominal pressure
o Decreased esophageal motility
– Indigestion, “heartburn,” and regurgitation are common
• 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
• Gastroesophageal Reflux Disease (cont’d)
• Nutrition therapy
– A 3-pronged approach is used to treat GERD
o Lifestyle modification, including nutrition therapy
o Drug therapy
o Surgical intervention, if necessary
– Lifestyle and diet modifications focus on reducing or eliminating behaviors believed to contribute to GERD
• 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
• 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
• 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
• 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
– Disorders of the Stomach (cont’d)
• Peptic ulcer disease (cont’d)
– Strategies that may help
o Avoid foods that stimulate gastric acid secretion, namely coffee (decaffeinated and regular), alcohol, and pepper
o Avoid eating 2 hours before bed
o Avoid individual intolerances
o 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
– Disorders of the Stomach (cont’d)
• Dumping syndrome (cont’d)
– Early
o Large volume of hypertonic fluid into the jejunum and an increase in peristalsis leads to nausea, vomiting, diarrhea, and abdominal pain
o Weakness, dizziness, and a rapid heartbeat occur as the volume of circulating blood decreases
o These symptoms occur within 10 to 20 minutes after eating
o Disorders of the Stomach (cont’d)
• Dumping syndrome (cont’d)
– Intermediate
o Occurs 20 to 30 minutes after eating
o Digested food is fermented in the colon, producing gas, abdominal pain, cramping, and diarrhea
– Late
o Occurs 1 to 3 hours after eating
• Disorders of the Stomach (cont’d)
• Dumping syndrome (cont’d)
– Late
o Rapid absorption of carbohydrate causes a quick spike in blood glucose levels
o Body compensates by oversecreting insulin
o Blood glucose levels drop rapidly
o Symptoms of hypoglycemia develop, such as shakiness, sweating, confusion, and weakness
• 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
– Disorders of the Stomach (cont’d)
• Dumping syndrome (cont’d)
– Nutrition therapy
o Eat small, frequent meals
o Eat protein and fat at each meal
o Avoid concentrated sugars
o Restrict lactose
o Consume liquids 1 hour before or after eating instead of with meals