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Nutrition for Patients with
Upper Gastrointestinal
Disorders
Chapter 17
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutrition 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
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Disorders 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
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Interventions 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
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Disorders That Affect Eating (cont’d)
• 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; and
pyloric or intestinal obstruction
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Disorders That Affect Eating (cont’d)
• Nausea and vomiting (cont’d)
– 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 common-sense
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
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Disorders That Affect Eating (cont’d)
• Nausea and vomiting (cont’d)
– 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
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Disorders 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’s disease, and multiple sclerosis
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Disorders of the Esophagus (cont’d)
• Dysphagia (cont’d)
– 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
o National Dysphagia Diet
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Disorders of the Esophagus (cont’d)
• Nutrition therapy (cont’d)
– Speech or language pathologist (SLP) performs a
swallowing evaluation
– Recommends feeding techniques based on the
patient’s individual status
– Moist, semisolid foods are easiest to swallow
– 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)
• Nutrition therapy (cont’d)
– Thickened liquids are more cohesive than
thin liquids and are easier to control
o Often poorly accepted
– Various feeding techniques may facilitate
safe swallowing
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Gastroesophageal 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
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Gastroesophageal Reflux Disease (cont’d)
• Gastroesophageal reflux disease (GERD)
(cont’d)
– 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
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Gastroesophageal Reflux Disease (cont’d)
• Nutrition therapy
– A 3-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
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Gastroesophageal Reflux Disease (cont’d)
• Nutrition therapy (cont’d)
– 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 anti-reflux medications
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Disorders of the Stomach
• Peptic ulcer disease
– Approximately 15% of ulcers occur in the stomach
and the remaining 85% are in the duodenum
– H. pylori infection
– Second leading cause of peptic ulcers is the use of
nonsteroidal antiinflammatory drugs
– Pain from duodenal ulcers may be relieved by food
– Pain from gastric ulcers may be aggravated by
eating
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Disorders of the Stomach (cont’d)
• Peptic ulcer disease (cont’d)
– 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
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Disorders of the Stomach (cont’d)
• Peptic ulcer disease (cont’d)
– 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
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Disorders of the Stomach (cont’d)
• Peptic ulcer disease (cont’d)
– 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
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Disorders of the Stomach (cont’d)
• 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
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Disorders of the Stomach (cont’d)
• Dumping syndrome (cont’d)
– 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
Copyright
© 2010 Wolters
Kluwer Health | Lippincott Williams & Wilkins
Disorders of the Stomach (cont’d)
• Dumping syndrome (cont’d)
– 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
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Disorders of the Stomach (cont’d)
• Dumping syndrome (cont’d)
– Late
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
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Disorders of the Stomach (cont’d)
• Dumping syndrome (cont’d)
– Increased risk of maldigestion,
malabsorption, and decreased oral intake
– 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)
– 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
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