Gastritis and Peptic Ulcers Quiz

Diet Therapy for Gastrointestinal Disorders

• This document details diet therapy for various gastrointestinal disorders.

Diseases of the Small Intestine

• Celiac disease
• Inflammatory bowel disease
• Crohn's disease
• Intestinal obstruction
• Irritable bowel syndrome
• Peptic ulcer

Diseases of the Large Intestine

• Colorectal cancer
• Colonic polyps
• Ulcerative colitis (ulcers of the colon and rectum)
• Diverticulitis (inflammation or infection of pouches in the colon)
• Irritable bowel syndrome

Common Intestinal Symptoms

• Intestinal gas and flatulence
• Constipation
• Diarrhea
• Steatorrhea (fatty stool)
• Gastrointestinal obstruction

Constipation

• Definition: Infrequent or difficult bowel movements, a symptom, not a disease.
• Accompanied by: Abdominal discomfort, headaches, backaches, gas (flatulence).
• Causes: Fluid/electrolyte imbalance, hormonal imbalance, chronic laxative abuse, lack of physical activity, certain medications (antiacids, antihypertensives), pregnancy, aging.

High-Fiber Diets

• Increase consumption of whole grains (6-11 servings daily)
• Increase consumption of fruits, vegetables, legumes, nuts, and seeds (5-8 servings daily)
• Increase fiber intake to 25g (women), 38g (men), or more daily.
• Increase fluid intake to at least 2 liters (or approximately 2 quarts) daily.

Diarrhea

• Definition: Watery stool, increased frequency, a symptom not a disease.
• Associated symptoms: Foul smelling stool, blood, abdominal pain/cramping, dehydration, weight loss, electrolyte/acid-base imbalance.

Medical Nutrition Intervention (for Diarrhea)

• Treat underlying diseases (e.g., antibiotics)
• Restore fluid, electrolyte, acid-base balance (e.g., IV, rehydration solutions)
• Medications to treat symptoms
• Prevention strategies

Steatorrhea

• Definition: Fat in the stool, causing bulky, oily/greasy appearance, and foul smell.
• Cause: Impaired fat absorption by the digestive tract
• Related conditions: Problems with the biliary tract, pancreas, or intestines.
• Diagnosis aids: Pale colored fatty stool, jaundice.
• Cause of absent pancreatic lipases: diseased pancreas, cystic fibrosis, birth abnormalities.

Medical Nutrition Intervention (for Steatorrhea)

• Increase calories, especially protein and carbohydrates.
• Control fat intake (as tolerated).
• Use medium-chain triglycerides (MCT) oil cautiously to meet caloric needs.
• Vitamin and mineral supplements (especially fat-soluble vitamins like Ca, Mg, Zn, Fe).

MCT Facts

• Man-made fat from coconut and palm kernel oils.
• More efficient absorption than long-chain fatty acids (LCFAs)
• Transported directly to the liver, unlike LCFAs.
• Used as a medical intervention.

Gastritis and Peptic Ulcers

• Gastritis: Nonspecific inflammation of the stomach;
• Acute: Rapid onset of inflammation and symptoms
• Chronic: Occurs over months to decades, with recurring symptoms
• Peptic ulcer: Ulcer in the stomach (gastric ulcer) or upper duodenum (duodenal ulcer).
• Risk factors: Helicobacter pylori, genetics/ethnicity, age, environment (alcohol, smoking, certain medications like aspirin, steroids, non-steroidal anti-inflammatory drugs).
• Symptoms: Nausea, vomiting, anorexia, hemorrhage, epigastric pain.
• Prolonged gastritis: atrophy of stomach parietal cells, loss of HCl secretion, and intrinsic factor (pernicious anemia)
• Importance of normal gastric and duodenal mucosa: mucus, bicarbonate, normal blood flow, renewal, repair of epithelial cell injury.
• Peptic ulcer symptoms: epigastric discomfort/burning, worse at night, 1–3hrs post-eating, nausea, vomiting, gastrointestinal discomfort, flatulence, significant weight loss.
• Medical nutrition intervention (MNI): Vitamin B12 evaluation, importance of low acid states on nutrient absorption, protein foods to buffer stomach acids.
• Diet therapy for peptic ulcers: Milk/cream is no longer considered helpful, the pH in food has little therapeutic value for patients without mouth/esophagus lesions.

Hiatal Hernia

• Definition: Portion of the stomach swells through the diaphragm opening.
• Symptoms: Heartburn (most common).
• Causes: Pregnancy, obesity, age, congenital weakness of the diaphragm.
• Complication: Esophageal reflux, iron deficiency anemia, food mixing with acid/pepsin; vomiting.
• Treatment: Antacids, surgery.

Dietary Modification (for Hiatal Hernia)

• Small, frequent meals.
• Avoid foods that irritate or increase acid secretion.
• No food within three hours of bedtime.
• Remain upright after eating.

Inflammatory Bowel Disease (IBD)

• IBD: Chronic disorder affecting the gastrointestinal tract, causing intestinal inflammation and mucosal injury; Increased expression of cytokines.
• Types: Crohn's disease (CD), ulcerative colitis (UC)

IBD Place and Pattern of Occurrence

• Crohn's disease (CD): Often (but not always) in the ileum. Can spread to the colon.
• Ulcerative colitis (UC): Typically in the colon. Sometimes spreads to the entire intestine.

IBD Nature of Inflammation

• Crohn's disease (CD): Inflammation involving the mucosa and submucosa (transmural).
• Ulcerative colitis (UC): Inflammation is limited to the mucosa.

IBD Etiology and Pathogenesis

• Multifactorial, likely involving environmental triggers and genetics, and immune response.

IBD Risk Factors

• Race: Crohn’s Disease is more common in some Western races, Ulcerative Colitis is more common in some Western countries (Europe, North America)
• Age: Young adulthood.
• Gender: Equally affected.
• Smoking

IBD Nutritional Problems

• Weight loss and anemia
• Poor growth in children, due to malnutrition,corticosteroids.
• Decreased bone mineral density.
• Vitamin D deficiency; calcium intake and absorption issues
• Macro/Micro nutrient deficiencies
• Vitamin and energy deficiencies

IBD Medical Nutrition Intervention

• Restore and maintain nutritional status; promote immunity and healing.
• Control signs and symptoms.
• Prevent nutrient deficiencies.
• Maintain normal growth (children)
• Nutritional assessment

IBD Dietary Intervention

• Adjust the diet during remission and flares
• Recognize triggers (foods that cause symptoms like bloating, gas, diarrhea).

Calories and Macronutrients (for IBD)

• Energy needs are not generally increased (unless weight gain desired)
• Protein needs may increase depending on severity/disease stage, treatment
• Inflammation/corticosteroids often cause negative nitrogen balance (muscle loss)

IBD Route of Delivery

• Enteral Nutrition (EN): Not as effective as corticosteroids for adults, but more effective for children.
• Parenteral Nutrition (PN) used for insufficient bowel function.
• The preference is for Enteral Nutrition, when bowel function length is adequate.

IBD During Flares

• Lower fiber/de-caffeinated drinks for adequate hydration
• Lactose, fructose, and high-fat intake may cause abdominal problems (cramps, gas, diarrhea; steatorrhea).
• Small, frequent feedings are better tolerated than large meals.

Celiac Disease

• Characterized by malabsorption of nutrients; thought to be hereditary.
• Symptoms can appear in infancy or adulthood. Trigged during GI surgery, stress, pregnancy, or viral infection issues.
• Symptoms: Nausea, vomiting, abdominal cramps, distention, diarrhea, steatorrhea, brain fog, bulky stool that's greasy/watery, micronutrient deficiencies, and growth failure.

Celiac Disease—Etiology and Pathogenesis

• Often triggered by gluten consumption.
  • Gluten peptides resistance to digestion may reach small intestine
  • Response involving immune system and inflammation that triggers small intestine damage.
  • Leading to the atrophy of villi and microvilli; low surface area; malabsorption.

Gluten Sensitivity vs Intolerance

• Gluten sensitivity might not involve gluten-related intestinal damage,
• Gluten intolerance (non-celiac gluten sensitivity) is where people experience symptoms even without significant gluten-related intestinal damage.

Celiac Disease—Medical Nutrition Interventions (MNI)

• Gluten-Free Diet
  • Eliminate all wheat, rye, and barley.
  • Read labels carefully for hidden gluten.

Diverticular Disease

• Pouches (diverticula) develop in the colon wall.
• Diverticulosis: Pouches, but not inflamed.
• Diverticulitis: Inflamed pouches, with associated symptoms.
• Risk factors: Low fiber intake, constipation, increased pressure.

Diverticular Disease (Diverticulosis) Management

• High-fiber diet: Increase stool volume, decrease pressure within the colon, less time for bacteria to grow.

Diverticular Disease (Diverticulitis) Management

• Clear liquid diet, followed by a low-residue diet.
• Reduce symptoms of diarrhea, bloating, gas, and cramping.

Irritable Bowel Syndrome (IBS)

• Functional disorder affecting the digestive system, marked by altered intestinal motility/sensitivity of gastrointestinal tract, increased visceral awareness, abdominal pain, and bloating, which can include either diarrhea or constipation.
• More common in women, and can start in early adulthood.
• Risk factors: Psychological stress, infection (gastroenteritis), certain medications.

Irritable Bowel Syndrome (IBS)—Management

• Relaxation, stress-reduction techniques.
• Avoid triggering foods (FODMAPs, high-fiber foods, which may cause gas/bloating, high-fat foods).

Test your knowledge on chronic inflammation of the gastric mucosa, the evaluation of medical nutrition interventions, and the risk factors associated with peptic ulcers. This quiz covers critical aspects of digestive health, including symptoms, dietary components, and the impact of medications. Prepare to enhance your understanding of gastritis and related gastrointestinal conditions.