Nutrition for Patients with Upper Gastrointestinal

Disorders

Chapter 17

Nutrition for Patients with Upper Gastrointestinal

Disorders

Chapter 17

Nutrition for Patients With Gastrointestinal DisordersNutrition 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 EatingDisorders 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 AnorexiaInterventions 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.)Disorders That Affect Eating—(cont.)

• 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

o Pyloric or intestinal obstruction

Disorders That Affect Eating—(cont.)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.

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.)Disorders That Affect Eating—(cont.)• Nausea and vomiting—(cont.)

– 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 EsophagusDisorders 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.

Disorders of the Esophagus—(cont.)Disorders of the Esophagus—(cont.)• Dysphagia—(cont.)

– 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.

Disorders of the Esophagus—(cont.)Disorders of the Esophagus—(cont.)• Dysphagia—(cont.)

– Nutrition therapy—(cont.)

o Speech or language pathologist (SLP) performs a swallowing evaluation.

o Recommends feeding techniques based on the patient’s individual status

o Moist, semisolid foods are easiest to swallow.

o 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.)Disorders of the Esophagus—(cont.)

• Dysphagia—(cont.)

– Nutrition therapy—(cont.)

o Thickened liquids are more cohesive than thin liquids and are easier to control.

Often poorly accepted

o Various feeding techniques may facilitate safe swallowing.

Gastroesophageal Reflux DiseaseGastroesophageal 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.)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.

Gastroesophageal Reflux Disease—(cont.)Gastroesophageal Reflux Disease—(cont.)• Nutrition therapy

– A three-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.)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.

Disorders of the StomachDisorders 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.

Disorders of the Stomach—(cont.)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.

Disorders of the Stomach—(cont.)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.

Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)

• Peptic ulcer disease—(cont.)

– 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.

Disorders of the Stomach—(cont.)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

Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)• Dumping syndrome—(cont.)

– 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.

Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)

• Dumping syndrome—(cont.)

– 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.)Disorders of the Stomach—(cont.)

• Dumping syndrome—(cont.)

– Late—(cont.)

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.)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.

Disorders of the Stomach—(cont.)Disorders of the Stomach—(cont.)

• Dumping syndrome—(cont.)

– 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.