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Nutrition for Patients with
Upper Gastrointestinal
Disorders
Chapter 17
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.
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.
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.
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.)
• 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.)
• 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 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.)
• 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.)
• 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.)
• 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 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 (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.)
• 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.)
• 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 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.)
• 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.)
• 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.)
• 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.)
• 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.)
• 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.)
• 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.)
• 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.)
• 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.)
• 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.