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Nutrition for Patients with Upper Gastrointestinal Disorders
Chapter 17
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Nutrition for Patients With Gastrointestinal Disorders
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Nutrition therapy is used in the treatment of many digestive system disorders
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Some diet therapy is only supportive
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Some diet therapy is cornerstone of treatment
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Disorders That Affect Eating
Anorexia
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Common symptom of many physical conditions
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Side effect of certain drugs
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Emotional issues
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Aim of nutrition therapy is to stimulate the appetite to maintain adequate nutritional
intake
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Interventions That May Help Anorexia
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Serve food attractively and season it according to individual taste
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Schedule procedures and medications when they are least likely to interfere with meals, if
possible
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Control pain, nausea, or depression with medications as ordered
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Provide small frequent meals
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Withhold beverages for 30 minutes before and after meals
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Offer liquid supplements between meals
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Limit fat intake if fat is contributing to early satiety
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Disorders That Affect Eating (cont’d)
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Nausea and vomiting
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May be related to:
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A decrease in gastric acid secretion
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A decrease in digestive enzyme activity
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A decrease in gastrointestinal motility, gastric irritation, or acidosis
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Bacterial and viral infection, increased intracranial pressure, equilibrium
imbalance
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Liver, pancreatic, and gallbladder disorders; and pyloric or intestinal obstruction
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Disorders That Affect Eating (cont’d)
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Nausea and vomiting (cont’d)
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Short-term concern of nausea and vomiting is fluid and electrolyte balance
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With intractable or prolonged vomiting, dehydration and weight loss are concerns
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Nutrition intervention for nausea is a common-sense approach
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Food is withheld until nausea subsides
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Clear liquids are offered and progressed to a regular diet as tolerated
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Small meals of easily digested carbohydrates
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Disorders That Affect Eating (cont’d)
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Nausea and vomiting (cont’d)
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Interventions that might help
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Encourage the patient to eat slowly and not to eat if he or she feels nauseated
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Promote good oral hygiene with mouthwash and ice chips
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Limit liquids with meals
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Serve foods at room temperature or chilled
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Avoid high-fat and spicy foods if they contribute to nausea
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Disorders of the Esophagus
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Symptoms range from difficulty swallowing and the sensation that something is stuck in the
throat to heartburn and reflux
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Dysphagia
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Impairments in swallowing can have a profound impact on intake and nutritional status
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Mechanical causes include obstruction, inflammation, edema, and surgery of the throat
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Neurologic causes include amyotrophic lateral sclerosis (ALS), myasthenia gravis,
cerebrovascular accident, traumatic brain injury, cerebral palsy, Parkinson’s disease, and
multiple sclerosis
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Disorders of the Esophagus (cont’d)
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Dysphagia (cont’d)
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Nutrition therapy
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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
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Emotionally, dysphagia can affect quality of life
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National Dysphagia Diet
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Disorders of the Esophagus (cont’d)
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Nutrition therapy (cont’d)
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Speech or language pathologist (SLP) performs a swallowing evaluation
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Recommends feeding techniques based on the patient’s individual status
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Moist, semisolid foods are easiest to swallow
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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”
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Disorders of the Esophagus (cont’d)
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Nutrition therapy (cont’d)
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Thickened liquids are more cohesive than thin liquids and are easier to control
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Often poorly accepted
Various feeding techniques may facilitate safe swallowing
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Gastroesophageal Reflux Disease
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Gastroesophageal reflux disease (GERD)
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Caused by an abnormal reflux of gastric contents into the esophagus related to an
abnormal relaxation of the lower esophageal sphincter
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Other contributing factors
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Increased intra-abdominal pressure
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Decreased esophageal motility
Indigestion, “heartburn,” and regurgitation are common
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Gastroesophageal Reflux Disease (cont’d)
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Gastroesophageal reflux disease (GERD) (cont’d)
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Pain frequently worsens when the person lies down, bends over after eating, or wears
tight-fitting clothing
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Chronic untreated GERD may cause reflux esophagitis, dysphagia, adenocarcinoma,
esophageal ulcers, and bleeding
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Gastroesophageal Reflux Disease (cont’d)
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Nutrition therapy
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A 3-pronged approach is used to treat GERD
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Lifestyle modification, including nutrition therapy
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Drug therapy
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Surgical intervention, if necessary
Lifestyle and diet modifications focus on reducing or eliminating behaviors believed to
contribute to GERD
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Gastroesophageal Reflux Disease (cont’d)
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Nutrition therapy (cont’d)
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Elevate the head of the bed 6 to 8 inches and avoid lying down for 3 hours after meals
to limit esophageal acid exposure
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Avoid alcohol
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Avoid spicy food
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Limit fat intake
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Limit caffeine, chocolate, and peppermint
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Take anti-reflux medications
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Disorders of the Stomach
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Peptic ulcer disease
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Approximately 15% of ulcers occur in the stomach and the remaining 85% are in the
duodenum
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H. pylori infection
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Second leading cause of peptic ulcers is the use of nonsteroidal antiinflammatory drugs
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Pain from duodenal ulcers may be relieved by food
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Pain from gastric ulcers may be aggravated by eating
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Disorders of the Stomach (cont’d)
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Peptic ulcer disease (cont’d)
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After nausea and vomiting subside, low-fat carbohydrate foods, such as crackers, toast,
oatmeal, and bland fruit, usually are well tolerated
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Patients should avoid liquids with meals because liquids can promote the feeling of
fullness
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Pain, food intolerances, or loss of appetite may impair intake and lead to weight loss
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Iron-deficiency anemia can develop from blood loss
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Disorders of the Stomach (cont’d)
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Peptic ulcer disease (cont’d)
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No evidence that diet causes peptic ulcer disease or speeds ulcer healing
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Some evidence suggests that a high-fiber diet, especially soluble fiber, may reduce the
risk of duodenal ulcer
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Nutrition intervention may play a supportive role in treatment by helping to control
symptoms
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Disorders of the Stomach (cont’d)
Peptic ulcer disease (cont’d)
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Avoid foods that stimulate gastric acid secretion, namely coffee (decaffeinated
and regular), alcohol, and pepper
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Avoid eating 2 hours before bed
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Avoid individual intolerances
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Disorders of the Stomach (cont’d)
Dumping syndrome
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Common complication of gastrectomy and gastric bypass is dumping syndrome
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Group of symptoms caused by rapid emptying of stomach contents into the intestine
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Disorders of the Stomach (cont’d)
Dumping syndrome (cont’d)
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Strategies that may help
Early
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Large volume of hypertonic fluid into the jejunum and an increase in peristalsis
leads to nausea, vomiting, diarrhea, and abdominal pain
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Weakness, dizziness, and a rapid heartbeat occur as the volume of circulating
blood decreases
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These symptoms occur within 10 to 20 minutes after eating
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Disorders of the Stomach (cont’d)
Dumping syndrome (cont’d)
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Intermediate
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Occurs 20 to 30 minutes after eating
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Digested food is fermented in the colon, producing gas, abdominal pain,
cramping, and diarrhea
Late
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Occurs 1 to 3 hours after eating
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Disorders of the Stomach (cont’d)
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Dumping syndrome (cont’d)
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Late
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Rapid absorption of carbohydrate causes a quick spike in blood glucose levels
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Body compensates by oversecreting insulin
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Blood glucose levels drop rapidly
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Symptoms of hypoglycemia develop, such as shakiness, sweating, confusion,
and weakness
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Disorders of the Stomach (cont’d)
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Dumping syndrome (cont’d)
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Increased risk of maldigestion, malabsorption, and decreased oral intake
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Excretion of calories and nutrients produces weight loss and increases the risk of
malnutrition
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Disorders of the Stomach (cont’d)
Dumping syndrome (cont’d)
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Nutrition therapy
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Eat small, frequent meals
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Eat protein and fat at each meal
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Avoid concentrated sugars
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Restrict lactose
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Consume liquids 1 hour before or after eating instead of with meals