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Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders

Medical Nutrition Therapy for Upper Gastrointestinal Tract Disorders

Chapter 29Chapter 29

© 2004, 2002 Elsevier Inc. All rights reserved.

Disorders of the EsophagusDisorders of the Esophagus

1. Gastroesophageal reflux disease (GERD)

—Backward flow of the stomach and/or duodenal contents into the esophagus

—Burning sensation after meals; heartburn

—Possible discomfort during and after eating, change in eating habits, especially in

the evening

1. Gastroesophageal reflux disease (GERD)

—Backward flow of the stomach and/or duodenal contents into the esophagus

—Burning sensation after meals; heartburn

—Possible discomfort during and after eating, change in eating habits, especially in

the evening


Disorders of the Esophagus—cont’dDisorders of the Esophagus—cont’d

2. Hiatal hernia

—An outpouching of a portion of the stomach into the chest through the esophageal

hiatus of the diaphragm

—Heartburn after heavy meals or with reclining after meals

—May worsen GERD symptoms

2. Hiatal hernia

—An outpouching of a portion of the stomach into the chest through the esophageal

hiatus of the diaphragm

—Heartburn after heavy meals or with reclining after meals

—May worsen GERD symptoms


Disorders of the Esophagus—cont’dDisorders of the Esophagus—cont’d

3. Cancer of the oral cavity, pharynx, and esophagus

—Existing nutritional problems and eating difficulties caused by the tumor mass, obstruction, oral infection and ulceration, or alcoholism

—Chewing, swallowing, salivation, and taste acuity are often affected.

—Weight loss is common.

3. Cancer of the oral cavity, pharynx, and esophagus

—Existing nutritional problems and eating difficulties caused by the tumor mass, obstruction, oral infection and ulceration, or alcoholism

—Chewing, swallowing, salivation, and taste acuity are often affected.

—Weight loss is common.


Common Symptoms of Gastrointestinal DiseaseCommon Symptoms of Gastrointestinal Disease


Nutritional Care Guidelines for Patients with Reflux and EsophagitisNutritional Care Guidelines for Patients with Reflux and Esophagitis

(Adapted from Bray GA. Gray DS, Obesity, part 1: Pathogenisis. West J Med 149:429, 1988; and Lew EA, Garfinkle L; Variations in mortality by weight among 750,000 men and women. J Clin Epidemiol 32:563, 1979.)


Disorders of the StomachDisorders of the Stomach

1. Indigestion/dysphagia

—Epigastric discomfort following meals

—Abdominal pain, bloating, nausea, regurgitation, and belching

—Eat slowly, chew thoroughly, and do not eat or drink excessively.

1. Indigestion/dysphagia

—Epigastric discomfort following meals

—Abdominal pain, bloating, nausea, regurgitation, and belching

—Eat slowly, chew thoroughly, and do not eat or drink excessively.


Disorders of the Stomach—cont’dDisorders of the Stomach—cont’d

2. Gastritis

—Helicobacter pylori

—Infection and inflammation

—Acute gastritis: rapid onset of inflammation and symptoms

—Chronic gastritis: occurs over period of time

—Symptoms: nausea, vomiting, malaise, anorexia, hemorrhage, and epigastric pain

2. Gastritis

—Helicobacter pylori

—Infection and inflammation

—Acute gastritis: rapid onset of inflammation and symptoms

—Chronic gastritis: occurs over period of time

—Symptoms: nausea, vomiting, malaise, anorexia, hemorrhage, and epigastric pain


Disorders of the Stomach—cont’dDisorders of the Stomach—cont’d

3. Peptic ulcer disease

—Primary causes: H. pylori infection, gastritis, use of NSAIDs, corticosteroids, and so-called stress ulcers

—Involves gastric and duodenal regions

—Gastric ulcers: in stomach; normal or low acid secretion

—Duodenal ulcers: in duodenum; high acid secretion

3. Peptic ulcer disease

—Primary causes: H. pylori infection, gastritis, use of NSAIDs, corticosteroids, and so-called stress ulcers

—Involves gastric and duodenal regions

—Gastric ulcers: in stomach; normal or low acid secretion

—Duodenal ulcers: in duodenum; high acid secretion


Characteristics and Comparisons Between Gastric and Duodenal UlcersCharacteristics and Comparisons Between Gastric and Duodenal Ulcers

Gastric ulcer formation involves inflammatory involvement of acid-producing cells but usually occurs with low acid secretion.

Duodenal ulcers are associated with high acid and low bicarbonate secretion.

Increased mortality and hemorrhage are associated with gastric ulcers.

Gastric ulcer formation involves inflammatory involvement of acid-producing cells but usually occurs with low acid secretion.

Duodenal ulcers are associated with high acid and low bicarbonate secretion.

Increased mortality and hemorrhage are associated with gastric ulcers.


Peptic Ulcer–CausePeptic Ulcer–Cause

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000. Updated by Peter L. Beyer, 2002.


Peptic Ulcer—PathophysiologyPeptic Ulcer—Pathophysiology

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.


Peptic Ulcer—Medical and Nutritional ManagementPeptic Ulcer—Medical and Nutritional Management

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000. Updated by Peter L. Beyer, 2002.


Gastric and Duodenal UlcersGastric and Duodenal Ulcers


Factors That Affect Gastric AcidityFactors That Affect Gastric Acidity


Gastric Surgical ProceduresGastric Surgical Procedures


Gastric Surgical Procedures—cont’dGastric Surgical Procedures—cont’d


Dumping SyndromeDumping Syndrome

Complex physiologic response to the rapid emptying of hypertonic contents into the duodenum and jejunum

Dumping syndrome occurs as a result of total or subtotal gastrectomy and is associated with mild to severe symptoms including abdominal distention, systemic systems (bloating, flatulence, pain, diarrhea), and reactive hypoglycemia.

Complex physiologic response to the rapid emptying of hypertonic contents into the duodenum and jejunum

Dumping syndrome occurs as a result of total or subtotal gastrectomy and is associated with mild to severe symptoms including abdominal distention, systemic systems (bloating, flatulence, pain, diarrhea), and reactive hypoglycemia.


Nutritional Care Guidelines for Patients with Dumping Syndrome and Alimentary HypoglycemiaNutritional Care Guidelines for Patients with Dumping Syndrome and Alimentary Hypoglycemia


Drugs Commonly Used to Treat Gastrointestinal DisordersDrugs Commonly Used to Treat Gastrointestinal Disorders Antacids: lower acidity

Cimetidine (Tagamet), ranitidine (Zantac): block acid secretion by blocking histamine H2 receptors

Prostaglandins

Sucralfate: coats and protects surface

Colloidal bismuth: coats and protects surface

Carbenoxolone: strengthens mucosal barrier

Tinidazole: antibiotic

Antacids: lower acidity

Cimetidine (Tagamet), ranitidine (Zantac): block acid secretion by blocking histamine H2 receptors

Prostaglandins

Sucralfate: coats and protects surface

Colloidal bismuth: coats and protects surface

Carbenoxolone: strengthens mucosal barrier

Tinidazole: antibiotic


DysphagiaDysphagia

Oral phase problemsPocketing foodDrinking from cup or strawDrooling

Pharyngeal phaseGaggingChokingNasal regurgitation

Esophageal phaseObstruction

Oral phase problemsPocketing foodDrinking from cup or strawDrooling

Pharyngeal phaseGaggingChokingNasal regurgitation

Esophageal phaseObstruction


Diagnosis of Swallowing DifficultiesDiagnosis of Swallowing Difficulties

1. Barium swallow

2. Cookie swallow

—Record your observations during meals

—Treatment

—Adapt consistency of food: thickened liquids puddings, custards, pureed; chopped or diced foods

1. Barium swallow

2. Cookie swallow

—Record your observations during meals

—Treatment

—Adapt consistency of food: thickened liquids puddings, custards, pureed; chopped or diced foods


Diseases of StomachDiseases of Stomach

Indigestion

Acute gastritis from: H. pylori tobacco, chronic use of drugs such as:

—Alcohol

—Aspirin

—Nonsteroidal antiinflammatory agents

Indigestion

Acute gastritis from: H. pylori tobacco, chronic use of drugs such as:

—Alcohol

—Aspirin

—Nonsteroidal antiinflammatory agents


Diseases of Stomach—cont’dDiseases of Stomach—cont’d

Chronic gastritis

Precedes gastric lesion like cancer or ulcer

H. pylori infection may cause

Sx—Indigestion, loss of appetite, feeling full, belching, epigastric pain, nausea, vomiting

Chronic gastritis

Precedes gastric lesion like cancer or ulcer

H. pylori infection may cause

Sx—Indigestion, loss of appetite, feeling full, belching, epigastric pain, nausea, vomiting


Diseases of Stomach—cont’dDiseases of Stomach—cont’d

Rx: Avoid foods not tolerated; soft consistency; regular meals; chew foods

—Avoid highly seasoned foods; avoid excess liquid at meals

Atrophic gastritis:

—Stomach cells atrophy

—Loss of parietal cells—achlorhydria

—Lose IF for B12 absorption

Rx: Avoid foods not tolerated; soft consistency; regular meals; chew foods

—Avoid highly seasoned foods; avoid excess liquid at meals

Atrophic gastritis:

—Stomach cells atrophy

—Loss of parietal cells—achlorhydria

—Lose IF for B12 absorption


Peptic Ulcer DiseaseTreatment with DietPeptic Ulcer DiseaseTreatment with Diet

Reduce decaffeinated and regular coffee, cocoa, and tea intake

No alcohol or pepper

Avoid low-pH juices if they cause problems

Avoid irritating foods

Avoid food right before bedtime

Eat at least 3 small meals per day, 6 better

Reduce decaffeinated and regular coffee, cocoa, and tea intake

No alcohol or pepper

Avoid low-pH juices if they cause problems

Avoid irritating foods

Avoid food right before bedtime

Eat at least 3 small meals per day, 6 better


Disorders of the Stomach— Nutritional CareDisorders of the Stomach— Nutritional Care

Lifestyle changes are an important component of the nutrition care plan.

Patients with dyspepsia should avoid high-fat foods, sugar, caffeine, spices, and alcohol.

Lifestyle changes are an important component of the nutrition care plan.

Patients with dyspepsia should avoid high-fat foods, sugar, caffeine, spices, and alcohol.


Diabetic Gastroparesis (Gastroparesis Diabeticorum)Diabetic Gastroparesis (Gastroparesis Diabeticorum)

Delayed stomach emptying of solids

Etiology—autonomic neuropathy

Nausea, vomiting, bloating, pain

Insulin action and absorption of food not synchronized

Prescribe small frequent meals (may need liquid diet)

Adjust insulin

Delayed stomach emptying of solids

Etiology—autonomic neuropathy

Nausea, vomiting, bloating, pain

Insulin action and absorption of food not synchronized

Prescribe small frequent meals (may need liquid diet)

Adjust insulin


SummarySummary

Upper GI disorders—H. pylori plays an important role

Maintain individual tolerances as much as possible.

Upper GI disorders—H. pylori plays an important role

Maintain individual tolerances as much as possible.

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