Medical Therapeutic Nutrition 1: GI Disorders

Medical Therapeutic Nutrition 1: Nutritional Management of Gastrointestinal Disorders

• GI Disorders Effects: Malabsorption, discomfort with eating, anorexia, impaired intake, and food intolerances.

Major GI Tract Conditions

• Upper GI: Diarrhea, vomiting, dyspepsia (gastric indigestion), peptic and duodenal ulcers, constipation, abdominal pain, irritable bowel, hemorrhoids, anal fissure, dysphagia, hernia.
• Additional Upper GI conditions: Gallstones, appendicitis, malabsorption syndromes.
• Lower GI conditions: Ulcerative colitis, Crohn's disease, diverticular disease of the colon, diverticulitis, pancreatitis, and liver disease.
• Additional lower GI conditions: Food intolerance.

Disorders of the Esophagus

• E-sophagus: The tube connecting the pharynx to the stomach.
• Disorders: Dysphagia, Esophagitis, Gastroesophageal Reflux (GERD), Hiatal Hernia.
• Causes of Esophageal Disorders: Derangement of swallowing mechanism, obstruction, inflammation, or abnormal sphincter function.
• Dysphagia (CONT): Almost always accompanied by reduced food intake, leading to significant weight loss, compromised immune function, and high risk of dehydration.

Primary Aims of Dysphagia Management

• Assess: The swallowing problem.
• Determine: A safe and adequate feeding route.
• Determine: Appropriate food and fluid texture/consistency.
• Meet: Nutritional needs.
• Ensure: Adequate hydration status.
• Educate: Patient/caretakers.
• Monitor: Progress and ensure continuity of care.

Esophagitis (CONT)

• Causes: Ingesting caustic compounds (often medications like NSAIDs), repeated vomiting (especially self-induced in anorexia/bulimia).

Dietary Recommendations for Acute Esophagitis

• Avoid: Spicy foods (red/black pepper).
• Follow: A bland, soft diet.
• Eat: Small frequent meals.
• Severe: Esophagitis - low-fat liquid diet.
• Avoid: Acidic foods (citrus fruits, soft drinks, tomato) - can cause pain if esophagus is inflamed.

Gastroesophageal Reflux Disorders (GERD)

• Definition: Symptoms of mucosal damage produced by abnormal reflux of gastric contents into the esophagus. (Acid from stomach refluxes up into the esophagus).
• Symptoms: Burning sensation after meals, heartburn, regurgitation, symptoms are aggravated by recumbency/bending over, and relieved by antacids.
• Chronic GERD Symptoms: Substernal pain, belching, esophageal spasm.

Causes of GERD

• Esophageal sphincter weakness.
• Increased pressure within the stomach.
• High pressure from abdominal area (obesity/pregnancy)
• Hiatus hernia.
• Tobacco use.
• Delayed gastric emptying.
• Recurrent vomiting.

Complications of GERD

• Prolonged reflux can result in esophagitis (inflammation), esophageal ulceration, scarring, esophageal strictures, and dysphagia..
• GERD is distressing and its symptoms interfere with sleep, work, and overall quality of life.
• Prolonged/severe reflux can affect esophageal tissues and potentially lead to cancer.

Treatment and Nutritional Intervention of GERD

• Objectives: Prevent esophageal reflux, prevent pain and irritation of inflamed esophageal mucosa, decrease erosive capacity/acidity of gastric secretions.

Dietary Changes to Manage GERD

• Avoid eating several hours before sleep (late at night).
• Avoid large meals, especially desserts high in fat and protein (stimulates acid secretion, slows gastric emptying).
• Eat small frequent meals.
• Avoid drinking liquids with meals; drink between meals.
• Avoid lying down, lifting after large meals.
• Avoid highly spiced foods when inflammation exists.
• Avoid foods/drugs that lower pressure of LES (Dietary fat, alcohol, carminatives).
• Avoid foods that increase gastric acidity (black/red pepper, coffee, alcohol).
• Reduce weight if overweight.

Hiatus Hernia

• Diet therapy: aimed at decreasing symptoms (reflux/esophagitis) in people with reflux.
• Therapy: Similar to GERD and esophagitis.
• Dietary Management: Smaller low-fat meals, avoiding foods that increase gastric secretions.
• Surgery: Not always indicated, medication often controls symptoms.
• Preferred treatment: Diet.

This quiz focuses on nutritional management strategies for various gastrointestinal disorders. Explore conditions affecting both the upper and lower GI tract, as well as specific esophageal disorders. Enhance your understanding of how these issues impact nutritional intake and therapy.