Lower Gastrointestinal Disorders
Common Intestinal problems
1-Constipation
• Difficulty passing stools or infrequent bowel movements; often
diagnosed when individual has a fewer than 3 bowel
movements/week
Other symptoms may include:
• The passage of hard stool
• Excessive straining during defecation.
Constipation – Causes
• Low food intake
• Low-fiber diets
• Inactivity
•
Certain disorders : hypothyroidism, diabetes mellitus, and chronic
renal disease
• Neurological conditions may cause motor problems in the intestine
• Higher among women especially during pregnancy
• Increases somewhat with aging
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Side effects of medications and dietary supplements
such as :
1. aluminum-containing antacids,
2. iron and calcium supplements.
Constipation – Treatment
 Gradual increase in fiber – wheat bran, fruits ,vegetables and fiber
supplements 20-25 grams/day
High fiber diet :
 increase stool weight
 promote a more rapid transit of materials through the colon
 Add prunes or prune juice to the diet because it have mild laxative
effects
 Make sure that patient has sufficient fluid intake to prevent
dehydration, which draws water from the colon to increase hydration
in the rest of the body.
 Increasing daily exercise
 Laxatives may be prescribed
Laxatives work by:
1. Increasing stool weight
2. Increasing water content of the stool
3. Stimulating peristaltic contractions
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2- Diarrhea
• Diarrhea is characterized by passage of frequent, watery stools In
severe cases may cause dehydration and electrolyte imbalances If
chronic, may lead to weight loss and malnutrition
• Acute diarrhea: Lasts for less than several weeks.
• Chronic diarrhea: Lasts for a month or longer.
Types and causes of diarrhea
a-Osmotic diarrhea :
Unabsorbed nutrients attract water to the colon and increase fecal
water content
The usual causes include:
• Lactase deficiency
• High intake of poorly absorbed sugars like sorbitol, manitol or
fructose which retain fluids in the colon
b- Secretory diarrhea:
• Intestines are stimulated to secrete fluid that exceeds the colon’s
capacity for reabsorption
•
This type is often due to bacterial food poisoning, intestinal
inflammation
c- Motility disorders :
cause diarrhea by acceleration of entry of fluids into the colon, that
shortens the contact time needed for fluid reabsorption
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Nutrition therapy of diarrhea
• The nutrition prescription depends on the medical diagnosis and
severity of the condition.
1-Low-residue, low-fat, lactose-free diet:
2-Low residue diet limits foods that contribute to colonic residue, such as
those with large amounts of fiber, lactose, fructose.
3-Avoid gas-producing foods because it can increase intestinal distention
and cause additional discomfort
4-Avoid of fatty foods because it aggravate diarrhea
5-Avoid coffee and tea because caffeine stimulates GI motility and reduce
water reabsorption
6-Oral Rehydration therapy can be used in severe cases Containing water,
salts, glucose or sucrose
7-Commercial sports drinks are generally not recommended because their
sodium content is too low .May be used with salty snack
8-IV solutions are used in extreme dehydration.
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3- Fat Malabsorption
• Fat is the nutrient most frequently malabsorbed because both
digestive enzymes and bile must be present for its digestion
• It develops when an illness interferes with the production or
secretion of either bile or pancreatic lipase
• It develops also as a result of cancer radiation therapy which damage
the intestine mucosa.
• Motility disorders in the stomach of intestine cause fat
malabsorption because they prevent the normal mixing of dietary fat
with digestive enzymes.
• Fat Malabsorption is often evidenced by steatorrhea
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Steatorrhea:
Excessive fat in the stools resulting from fat malabsorption; characterized
by stools that are loose, frothy, and very bad smell due to a high fat content
Consequences of Fat Malabsorption
• Loss of energy and fatty acids
• Loss of Fat-soluble vitamins – A, D, E, K
• Loss of Minerals such as Calcium, magnesium, zinc because minerals
form soaps with unabsorbed fatty acids.
• Bone disease
• The risk of Kidney stones increase
• The oxalates in foods ordinarily bind to calcium in the small intestine
and are excreted in the stool.
• If calcium instead binds to unabsorbed fatty acids, oxalates are free
to be absorbed into the blood and are excreted in the urine.
• The risk of developing oxalate stones increases when urinary oxalate
levels are high.
Dietary adjustments for fat malabsorption
• Fat restricted diet is recommended to relive the symptoms
• Fat should not be restricted more than necessary
• Medium-chain triglycerides which do not require lipase or bile for
digestion and absorption may be used .It does not provide EFA and
give 8.1 kcal/g
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4-Lactose Intolerance
• High incidence: approximately 75% of population worldwide Rarely
serious and Most individuals (with lactose intolerance) can tolerate
milk if consumed with other foods & limit amount consumed at one
time.
Cause of lactose intolerance
• Lactose intolerance is the inability to digest and absorb lactose (the
sugar in milk) that results from reduction or loss of lactase, enzyme
that digests lactose in milk products
Symptoms of lactose intolerance
Symptoms of lactose intolerance usually begin 30 minutes to two hours
after eating or drinking foods that contain lactose. Symptoms are usually
mild, but they may sometimes be severe.
Common signs and symptoms include:
• Diarrhea
• Nausea
• Abdominal cramps
• Bloating
• Gas
Dietary management of lactose intolerance
• In the mild cases ,gradually increased consumption of lactosecontaining products
• Divide milk intake throughout the day
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• Consume milk with meals
• Chocolate milk may be better tolerated than plain
• Aged cheeses well tolerated especially hard cheese, which contains
very small quantities of lactose and is usually very rich in calcium (e.g.
parmesan, cheddar).
• Yogurts with live bacterial cultures that aid in lactose digestion
• Addition of lactase preparation to milk or use of enzyme tablet
before consumption
• patients can also try lactose-free milk ”soy milk”
5-Celiac Disease
A condition characterized by an abnormal immune reaction to wheat gluten
that causes severe intestinal damage and nutrient malabsorption.
Consequences of celiac disease
• The immune reaction to gluten causes severe damage to the small
intestine mucosa.
• Absorptive surface appears flattened due to shortening or absence of
villi.
• Results in malabsorption of macronutrients, fat-soluble vitamins,
electrolytes, calcium, magnesium, zinc, iron, folate, and vitamin
B12Develop anemia and low bone density.
• Individuals with celiac disease who do not eliminate gluten from the
diet are at increased risk of lymphatic and intestinal cancer.
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Symptoms of celiac disease
• Diarrhea
• Steatorrhea
• Flatulence
• Lactase deficiency may result from mucosal damage
•
children often have stunted growth, underweight
• Severe rash
• Individuals with celiac disease who do not eliminate gluten from the
diet are at increased risk of lymphotic and intestinal cancer.
Medical nutrition therapy of celiac disease
• Lifelong adherence to a gluten-free diet
• Avoid lactose-containing foods if lactase deficiency is found.
• Eliminate wheat, rye, barley
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• Read labels carefully – replace bread, pasta, cereal
• Can be social liability
• Diet counseling
Inflammatory Bowel Disease
• Conditions having patterns of inflammation. It is Complex set of
genetic and environmental factors (bacteria – irritant- viral)
contribute to the development but the exact cause is unknown.
Occurs most frequently in persons 15-25 years of age
1-Ulcerative Colitis
• An inflammatory bowel disease that involves the colon. Inflammation
affects the mucosa and submucosa of the intestinal wall.Involves
rectum and extends into the colon
•
Symptoms of Ulcerative colities:
 Diarrhea
 Rectal bleeding
 Abdominal pain
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Normal colon
Ulcerative Colitis
Complications – Ulcerative Colitis:
• Weight loss ,fever, weakness are common when most of the colon is
involved
• A decrease in the oral intake of nutrients is a common symptom and
is often due to abdominal pain fever
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• Mucosal inflammation and its associated diarrhea or bleeding lead to
a loss of protein, blood, minerals, electrolytes and trace elements.
• severe disease is often associated with anemia, dehydration, fluid &
electrolyte imbalances
• High risk of developing colon cancer – colectomy may be performed
(20-25%)
Medical therapy for ulcerative colitis:
• Drug therapy
 Antidiarrheal agents
 Immunosuppressants
 Anti-inflammatory agents
• Surgical interventions
Nutrition therapy for ulcerative colitis:
The primary goal are to:
•
Replace fluid and electrolyte losses
• Correction of deficiencies due to protein and blood losses
• Low-fiber diet may reduce irritation by minimizing fecal volume
• Bowel rest if colon function severely impaired : food and fluids may
be withheld and fluids and electrolytes supplied intravenously until
colon function is restored.
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Conditions Affecting the Large Intestine
1-Diverticular Disease of the colon
• Development of pebble-sized herniations in the intestinal wall known
as diverticula.Most often occurs in sigmoid colon
• Prevalence increases with age
• Development is influenced by the amount of dietary fiber a person
consumes
• Increasing the stool bulk by high fiber intake may reduce the
workload of the intestine muscle that moves the wastes through the
colon.
• Low-fiber diet increases the pressure in the intestine, causing small
areas of the intestinal wall to balloon outward over time.
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Diverticulitis :
Localized inflammation or infection develops in the area around a
diverticulum
• It is the most common complication of diverticulum
• Thought to result from hardened fecal matter that abrades the
mucosal lining
 Causes inflammation
 May cause microperforation – infection – fistulas – peritonitis
Symptoms of Diverticulitis
• Persistent abdominal pain
• Fever
• Constipation
• Bleeding
• Nausea & vomiting
Nutrition therapy for diverticular disease
• Gradual increase in dietary fiber – insoluble fibers
• Avoid nuts, popcorn, and foods that contain seeds to prevent
disease progression
• In mild cases clear liquid diet may be advised initially that is
gradually progressed to low-fiber, low-residue diet until
inflammation and bleeding subside
•
For severe cases bowel rest is necessary ( IV). Oral intake are
gradually started as condition improves.
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Medical treatment for diverticular disease
• Pain relief medication
• Antibiotics
• Surgical interventions may be needed for affected portion of colon
(colectomy
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