© 2007 Thomson - Wadsworth Chapter 17 Nutrition & Upper Gastrointestinal Disorders

© 2007 Thomson - Wadsworth

Chapter 17

Nutrition & Upper Gastrointestinal Disorders


Dry Mouth: Xerostomia

• Reduced salivary flow Side-effect of

medications Poorly controlled

diabetes Sjogren’s syndrome Radiation therapy Mouth breathing

• Consequences Increased plaque Tooth & gum disease Mouth infections Interference with speech Bad breath Difficulty chewing &

swallowing Diminished taste Ulcers from dentures Reduced food intake



Dysphagia: Difficulty Swallowing

• Oropharyngeal dysphagiaTransfer of food

from mouth to esophagus

Problem of tongue, other oral tissues or swallowing reflex

• Symptoms Inability to initiate

swallowingCoughing during or

after swallowingNasal regurgitationBad breath“Wet” voice

• Stroke is a frequent cause


Dysphagia: Difficulty Swallowing

• Esophageal dysphagiaTransfer of food

through esophagus to stomach

Complaints of “food sticking” after swallowing

• Causes Obstruction in

esophagus Motility disorder

• Aspiration: a potential complication of oropharyngeal or esophageal dysphagia



National Dysphagia Diet

• Level 1: Dysphagia pureedModerate to severe

dysphagiaPoor oral or chewing

ability

• Level 2: Dysphagia mechanically alteredMild to moderate

dysphagia

• Level 3: Dysphagia advancedMild dysphagia

• Level 4: Liquid consistenciesThinNectarlikeHoneylike Spoon-thick


Food Properties & Preparation

• OfferEasy to manage

textures & consistencies

Soft, cohesive foodsMoist rather than dryOne texture at a

timeThickeners Pureed, mashed,

ground, or minced

• AvoidSticky or gummy

foodsNuts & seedsMore than one

textureThin liquids

• Use a variety of colors & shapes


Gastroesophageal Reflux Disease

• GERD Reflux of acidic

stomach contents into the esophagus

Heartburn or acid indigestion

Causes discomfort & may cause tissue damage

• Conditions associated with GERD Pregnancy Asthma Hiatal hernia Obesity Large meals Some medications Nasogastric tubes

• Treatment Proton-pump inhibitors Histamine-2-receptor blocking

agents



Conditions Affecting the Stomach

• Dyspepsia• Nausea & Vomiting• Gastritis• Peptic Ulcer


Dyspepsia

• General discomfort in the upper abdominal area

• Teaching Small meals with

well-cooked foodsLightly seasonedRelaxed atmosphere

• CausesPeptic ulcersGERDMotility disordersMalabsorption disordersGallbladder diseaseTumors in abdominal

regionSome medications &

dietary supplements


Nausea & Vomiting

• Accompanies many illnesses

• Common side effect of many medications

• Correct underlying disorder

• May need to restore hydration

• Dietary interventionsEating & drinking

slowlySmall mealsClear, cold

beveragesDry salty foodsFoods cold or at

room temperature


Gastritis

• Inflammation of the stomach mucosa

• Causes Helicobacter pylori

infection Irritating substances Damage to stomach lining

(diseases/ treatments)

• Acute erosive gastritis or chronic atrophic gastritis

• Complications Low or absent

hydrochloric acid Impaired absorption of

nonheme iron & vitamin B12

• Dietary interventions Avoid alcohol, coffee,

tea, cola, spicy foods, & fatty, greasy foods


Peptic Ulcer

• Gastric & duodenal • Causes

Effects of hydrochloric acid & pepsin

Helicobacter pylori infection Non-steroidal anti-

inflammatory drugs

• Other risk factors Cigarette smoking Emotional stress Genetic factors


Peptic Ulcers

• Signs & symptomsHunger painSensation of gnawingBurning in stomach

• Complication GI bleeding

• Weak & fatigued• Black, tarry stools• Coffee ground vomit

• Drug therapyAntibiotics Discontinue aspirin &

NSAIDSAntisecretory agentsBismuth preparations

or sucralfate

• Avoid irritating foods • Avoid large meals


Gastric Surgery

• Treatment forSevere obesityPeptic ulcerStomach cancer


Gastrectomy

• Removal of diseased portions of the stomach

• Other Vagotomy:

suppresses acid secretion

Pyloroplasty: widens pyloric sphincter from stomach to the duodenum

• Postgastrectomy diet Several small meals & snacks Progress to 5-6 small

meals/day Avoid sweets & sugars Fiber to delay stomach

emptying Avoid irritating foods May need to avoid milk

products (lactose intolerance) Liquids between meals


Typical Gastric Surgery Resections



Post-Surgical Problems

• Dumping SyndromeAbnormally rapid

gastric emptyingGoals

• Limit amount of food reaching the intestine

• Slow rate of gastric emptying

• Reduce foods that increase hypertonicity

• Fat malabsorption Deficiencies of fat-

soluble vitamins & some minerals

• Bone disease Malabsorption of calcium

& vitamin D

• Anemia Impaired iron & vitamin

B12 absorption due to decreased hydrochloric acid



Bariatric Surgery

• Creates a gastric pouch which restricts meal size to about a cup

• Bypasses part of small intestine, decreasing absorption

• Lose between 49-62% of excess weight

• After weight loss, may need plastic surgery to remove excess skin

• Progressive diet• Fluids consumed

separately• Education on food

portions To avoid dumping

syndrome To maintain weight

loss

• Need dietary supplements


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© 2007 Thomson - Wadsworth Chapter 17 Nutrition & Upper Gastrointestinal Disorders