Nutrition & Pathophysiology of GI Disorders

Gastroesophageal Reflux Disease (GERD) and Gastroparesis

• GERD involves backflow of stomach contents into the esophagus due to lower esophageal sphincter dysfunction.
• Gastroparesis is a condition where the stomach empties slowly, leading to symptoms like nausea and bloating.
• Risk factors for GERD include obesity, smoking, pregnancy, and certain medications.
• Gastroparesis can be caused by diabetes, nerve damage, and certain medications.
• Consequences of untreated GERD include esophagitis, Barrett's esophagus, and increased risk of esophageal cancer.
• Gastroparesis may result in malnutrition, dehydration, and poor glycemic control in diabetic patients.

Nutrition Recommendations for GERD and Gastroparesis

• For GERD, avoid trigger foods such as spicy foods, chocolate, caffeine, and large meals.
• Incorporate smaller, more frequent meals to reduce gastric pressure.
• In gastroparesis, opt for foods that are low in fat and fiber, and easy to digest.
• Recommend pureed or liquid diets if solid foods are poorly tolerated.

Bariatric Surgery Diet Progression

• Initial post-operative diet consists of clear liquids for 1-2 days.
• Progression to full liquids, then soft foods at 2-3 weeks.
• Gradual transition to solid foods after 4-6 weeks, focusing on protein-rich options.
• Necessary supplements post-surgery include multivitamins, calcium, and vitamin B12.

Inflammatory Bowel Disease (IBD)

• Likely causes of IBD include genetic predisposition, immune system dysfunction, and microbial factors.
• Environmental triggers include diet, stress, and exposure to certain medications.
• Crohn's disease can occur anywhere in the gastrointestinal tract and presents as segmental inflammation.
• Ulcerative colitis primarily affects the colon and is characterized by continuous inflammation.

Nutrition in IBD Management

• During remission, a balanced diet with adequate fiber and hydration is encouraged.
• During flare-ups, low-residue diets may reduce symptoms and limit intestinal workload.
• Severe flare-ups require a low-fiber diet, and in some cases, enteral nutrition may be necessary.

Challenges Faced by Individuals with IBD

• Difficulty accessing suitable food options during travel or social events.
• Managing symptoms like urgency and diarrhea can lead to anxiety and social isolation.
• Nutritional deficiencies due to malabsorption and restrictive diets.

Nutrition Recommendations for Gastrectomy

• Post-gastrectomy nutrition focuses on small, frequent meals that are nutrient-dense.
• Emphasize high-protein foods and avoid simple carbohydrates to minimize dumping syndrome.
• Monitor for vitamin B12 deficiency and consider supplementation.

Ostomy Considerations

• Select type of ostomy based on location, e.g., ileostomy for small bowel involvement, colostomy for large intestine.
• Nutrition recommendations for 1-6 weeks post-ileostomy include hydration and low-fiber foods to reduce output.
• After 6 weeks, a balanced diet can be reintroduced, focusing on hydration and adequate electrolytes.
• Common ostomy concerns include odor management, skin care around the stoma, and dietary adjustments.

Short Bowel Syndrome Characteristics

• Short bowel syndrome occurs when a significant portion of the small intestine is absent or not functioning.
• Symptoms include diarrhea, weight loss, and malabsorption.

Management of Hepatic Encephalopathy

• Medical management includes lactulose and rifaximin to reduce ammonia levels.
• Nutritional management emphasizes adequate protein intake while preventing further liver damage.

Nutrition Recommendations for Liver Cirrhosis

• Encourage a well-balanced diet with adequate calories and protein to prevent malnutrition.
• Limit salt intake to manage ascites and fluid retention.
• Monitor vitamin and mineral intake, aiming for supplementation as needed.

This quiz covers various gastroenterological conditions, including gastroesophageal reflux disease, gastroparesis, and inflammatory bowel disease. It emphasizes pathophysiology, risk factors, dietary recommendations, and dietary progression post-bariatric surgery. Understand the key distinctions between Crohn's disease and ulcerative colitis as well as nutrition approaches during different disease states.