Nutrition in Gastrointestinal Diseases PDF

Nutrition in Gastrointestinal Diseases Department of Biochemistry Faculty of Pharmacy Suez Canal University CamScanner  I) Mouth disorders I11j11ry or clisease i11 the n1011tl1 (i.t1cl11dit1g lips, oral ca,,ity, tong1...

Nutrition in Gastrointestinal Diseases Department of Biochemistry Faculty of Pharmacy Suez Canal University CamScanner  I) Mouth disorders I11j11ry or clisease i11 the n1011tl1 (i.t1cl11dit1g lips, oral ca,,ity, tong11e, and 11aso1Jha1y1ix) can rapidly co1npro1nise n11tritional statl.1s by itlhibiting eating a11d drirlking. To co1111ter tl1is. 1111trie11t it1take ca11 be OJJtitnized t11ro11gl1 tl1e 1nodification of food text1.1re or by instigatit1g 1111tritional s11ppo11 ·via h1be feediI1g. ln.n tt Ch (bu~mucau) r 2011 p -: CamScanner  Cancer of the mouth and pharynx Mo11tl1 and phary11geal cancers accou11t for "-J6% ca11cers ,,rorld\\ride b11t are 11111cl1 1nore co111n1011 in developit1g co1111tries. Associated risk factors it1clude tl1e const1111ption of salted fish (11asopl1a1y11geal ca11cer) a11d cl1e,\rit1g betel 1111t or tobacco (oral cancer). High alcol1ol it1take a11d smoking are associated vvith it1creased - - risk a11d this is 11111ltiplied iI1 i11di,rid11als ,,rho 11nde1iake both activities. Treat1ne11t incl11des s11rge1y, chen1otherapy, ai1d radiotl1erapy and must i11cl11de it1di,ricl11al dieta1y ad,rice to 1naxiinize n11trie11t intake. CamScanner  Cancer of the mouth and pharynx Nl1tritional 111a11age1ne11t ca11 play a11 iI11po11a11t role d11rit1g each of these goals: , C11re: to obtain a complete resJJonse. ► Co11trol: to exte11d life and q11ality of life if c11re is 11ot possible. ► Palliatio11: to pro,ride con1fo11 wl1ere c11re and control are 11ot JJossible, to relie,,e syinptoms and maxitnize q11ality of life. CamScanner  Cancer of the mouth and phary x There is goocl evidence tl1at JJroviding n11tritional s11ppo11 can maximize the patient's n11tritional statl1s and limit cachexia~ enabling the patient to better withsta11d anticancer treatment. Anticancer treatment is most effective vvhen cancer cells are V11h1erable d11ring their proliferative phase s11ggestir1g tl1at provision of n11tTie11ts will 11ot have a11 acl,,erse effect. Tl1ere is no ratior1ale for lin1iting n11tritional intake in car1cer patients in order to 'struve' the tl1n1or. CamScanner  Suggestions to alleviate nutrition- related side-effects in cancer patients □ Anorexia Try to maxi1nize intake by taking high- energy/high-protein foods. Gentle exercise/fresh air before meal 1nay promote appetite. CamScanner  Suggestions to alleviate nutrition- related side-effects in cancer patients □ Dry n1011th Sip cool drinks. Try using a drinking straw. Suck ice chips. Sharp tastes like grapefruit or len1on n1ay stimulate saliva. Serve meals with sauce or gravy. CamScanner  Suggestions to alleviate nutrition- related side-effects in cancer patients □ N at1sea & vomiting Avoid off-putting sn1ells. Plai11 foods in s1nall quantities n1ay be better tolerated. Avoid lying.d own after eating, a gentle vvalk 1nay l1elp. CamScanner  Suggestions to alleviate nutrition- related side-effects in cancer patients □ Dia11·hea Avoid i11·itating foods that exacerbate, e.g. pulses, onions, strong spices. Consider reducing fiber-rich foods (including \Vhole grains, :fi.uit and vegetable intake if intake is ah'"ea.d y high). Ensure that fl11id it1take is adeq11ate and tty to keep eating eve11 if s1nall q11antities of smooth foods. Red11cing fat intake ru1d milk products is often s11ggested. This may l1ave a 11egative e:ffect on nutrient intake so individ11al advice from a. dietitian is req11ired. CamScanner  Suggestions to alleviate nutrition- related side-effects in cancer patients D Constipation Tl1is lllay ru:ise due to ca11cer, treatlllent, or analgesia or si1nply fi:0111 a poor i11take a11d iI1activity. Ea.ting n1ore and gentle exercise 111a.y l1elp. Increase fluid intake. Increasit1g i11take of fi1.1it, vegeta,b le, and ,;vhole gra.it1 cereals 1na,y help if tolerated. P1unes and p1une jt1ice. A little l1ot water on wakit1g 01ay stitnt1la.te the bo,\rel. CamScanner  Examples of side-effects 1 elated to specific 1 cytotoxic d1 ugs 1 Cisplatin: severe nausea & vomiting bt1t little mucositis... Doxorubicin: severe mucos1t1s (dose- dependent). 5-fluo,r ouracil: severe mucositis plus taste alterations. Vinblastine sulphate : mild-moderate nausea & vomiting plus constipation. CamScanner  II) Salivary gland disorders Disorders include saliv-ra deficiency, inflannnation seconda1y to iiifectio11, a11d calc11li. hrlla1111natio11 ca11 hiI1der cl1e,vi11g ai1d red11ce the flo\¥ of saliv~a., ftuther in1peding food intake. Treat1nent of the underlying conditio11 is reqt1ired ai1d 11ut1i.e11t i11take sl1ould be supported by providi11g 1noist food that reql1ll·es little cl1ewing. CamScanner  II) Salivary gland disorders Ja,i\r wiring Fixation of the 1naxilla/mandible n1ay be undertaken followii1g a fractl1red jaw, oral st1rge1y, or (rarely) in the treatn1ent of obesity. The procedt1re n1ay acco111pa11y cornplex rnaxofa.cial st1rge1y ii1 tl1e presence of severe t1·aun1a. or may be relatively stJ:aightforward in elective ja,v wii·ing for obesity. CamScanner  II) Salivary gland disorders N11tritional 111anagen1e11t A liq11id or se111i-liq11id diet is req11ired. Tl1is ca11 be based on a co1nbir1ation of s11pplemented driilk:s both hon1emade and co1nmercial, that can be sucked through '- tl1e gaps between the jaws. Co11sideratio11 n1ust be given to the total n11t1ient intake to ens11re adequacy for tl1e duration of the fixation (11s11ally 3-8 v.reeks follovving fi:actlrre). CamScanner  III) De. tal caries Caries (cavities, tooth decay) are holes in tl1e structure of the tooth. Dental Caries CamScanner  III) Dental caries P evention In addition to reducing plaque bacteria by regular brushing and flossing and reg,u lar dental visits, dietary 12revention includes: Minimizing effects of f ennentable carbohydrate: o sl1crose > fi11ctose o gl11cose, maltose > lactose o galactose > 1naltodextrins o polysaccharide > sorbitol, xylitol. CamScanner  III) Dental caries Sticky/chewy food leaves residue on teeth that prolongs exposure to carbohydrate and leads to a lower oral pH. Toffees and dried fruit have a greater potential to contrib11te to dental caries than the same qt1antity of carbohydrate taken as fruit juice which rapidly leaves the mouth. CamScanner  III) Dental caries Maximizing oral pH by : , Lirniting acidic food. ► Finishing 111eal with alkaline food, e.g. cheese or 1nilk. ivlilk a11d daily prodt1cts are alkaline and contain protein, calciun1, and phosphate ,vhich play a role in re-1nineralizit1g dental ena1nel follo,ving a.cid expostu·e. ► Drinking a.cidic drill.ks tln·ot1gh a. stra,v and 1 1ninitnizit1g sipping, svvishing, and frothing in the IllOllth. CamScanner  IV) Dysphagia. Dysphagia (discomfort, difficulty, or pam when svvallowing) is common in oesophageal disorders. Inflammation or occlusion of the oesophageal lu1nen impairs the fmal stage of swallo,v as food passes from the pharynx to the sto1nach. CamScanner  IV) Dysphagia In general, patients ,;vith more severe oesophageal disorders ,;vill require more liquids and thinner textures than those ,;vith milder dysphagia. The complete nutritional adequacy of the intake sl1ould be determined and progress monitored in the context of the underlying condition. CamScanner  V) Achalasia Achalasia is a rare disorder in which damaged nerves in the esophagus lead to food being retained in the oesophagus due to reduced peristalsis and incomplete opening of the lower oesophageal sphincter. Treatment includes balloon dilatation, surgery, or injection of botulinum toxin to relax the sphincter. CamScanner  V) Achalasia N11tritional 1na11age1ne11t 1nay also l1elp a11d it1cl11des sn1all fi·eque11t 1neals, avoidi11g foods tl1at exacerbate dyspepsia_ai1d ver)' hot or cold foods, ru1d not ea.ting late at 11igl1t or before lyit1g do,m1. Eating in an uprigl1t positio11 (rather tl1an reclini11g or slU111ped) rnay facilitate tl1e passa,ge of food it1to the sto1na,cl1. N11tritio11al assessn1e11t sho11ld be 11nde1iake11 to pre,,ent weight loss tl1rough a11 ii1adeq11ate it1take. CamScanner  VI) Nausea and vomiting Nausea and vomiting can have a significant effect on nutritional status by greatly reducing intake or preventing the digestion and abso·r ption of food consumed. These symptoms may relate to a gastrointestinal disorder, food poisoning, other syste1nic condition, e.g. uraemia, or treatment, e.g. chemotherapy. CamScanner  VI) Nausea and vomiting Nut itio a ntanageD1ent ► Try: Chilled foods a.s tl1ese 1nay be 1nore a.cceptable tha11 l1ot itellls. Pla.i11 foods i11 s1nall q11antities 1nay be better tolerated. Sip ch·iriks tln·ougl1out day bt1t wait for 15 1nir1 after eati11g before taking lllore fluid. Ginger fla.-\1ours, 1ni11ts a11d plair1 biscuits. CamScanner  VI) Nausea and vomiting Nut "it·ona D1anage1nent ► Avoicl: Off-putti11g s1nells (food or others). Foods that don't appeal-1nay inclucle spicy or grea.s y ite1ns. Lyit1g down after eating-a ge11tle walk 1na.y l1elp. Extreille l1unger by eatit1g stnall a1nounts re g11lai·ly. In severe cases, clel1ych'9ation 1nay be a co11cern ai1d oral rel1yclration solutio11 or intravenous fluids 1nay be requii·ed. CamScanner  VII) Gastritis and peptic ulcers Ga.sti·itis is the inflru:11111ation of mucosal surface of the sto1na.ch. It ca11 range fi:om a 1nild, a.syn1ptomatic fo11n to severe ulceration, which if tmtreated may lead to perforation. Peptic t1lcers it1clt1de lesions it1 the sto1na.ch and dt1odentnn. 80% of gastritis and peptic ulcers are associated with Helicobacte1· pyf011· infectio11 but a higl1 intake of alcohol and nonsteroidal anti-infl81Illl1ato1y d1ugs is also itnplicated. CamScanner  VII) Gastritis and peptic ulcers Noti·itional management In severe cases, patients have no desire to eat and 'resti11g' the stomacl1 fro111 food for 1-2 days 1nay help alleviate. pam. Adequate fl11id incl11cling sugar a11d electrolytes will 111iI1ilnize risk of dehydration. N11trie11t intake sl1ould be grad11ally increased over 1-3 days by providing other no11rishing tl11ids a11d then bland non-i11·itating foods. CamScanner  VII) Gastritis and peptic ulcers N t1~ittonal management Avoid ite1ns that exacerbate sy1npto1ns (often spicy, highly fla.voured foods with a lllgh fat co11tent). F1uit and juice ,¥ith perceptible acidity have traditionally bee11 avoided 011 tl1e grou11ds that these exacerbate gastric pH. CamScanner VIII) Gastrectomy and stomach surgery The type of surgical resection of the stomach, e.g. for cancer, perforation following severe ulceration or trau1natic injury, varies depending on the degree and position of the lesion to be removed. Go, le,,_ (n w stomMhl · - R O't por11on of stom h CamScanner VIII) Gastrectomy and stomach surgery Nut ·itiona · ntanage1nent: Reconnne11cing oral ir1take, usually in the f011n of cleai· fl11ids, sl1011ld be 1111de1taken as soo11 as possible after su1·ge1y. Gradually ir1crease fro111 liquids to solid food so tl1at i11 1nost cases so1ne solid food is beit1g taken 1 week post-op. Feeling fi1ll a.ft er ve1y sn1a.ll quai1tities of food is co1n1non, pa1ticulai·ly followir1g total gastrecto1ny, so ve1y s1nall 1neals eate11 fi·eq11e11tly (7 l1otu~1y, it1itia.lly) will l1elp to tnaxi11llze 11utrient intake arid th11s co11t1'ibute to healir1g. CamScanner VIII) Gastrectomy and stomach surgery N tritional inanageinent: Bulky foods and fizzy drinks 111ay be best avoided at first as these 111ay exacerbate feelings of fullness. Drinking separately from eating may also l1elp. CamScanner VIII) Gastrectomy and stomach surgery Nutritional management: Dumping syndro1ne is caused by the rapid move1nent of dietaiy sugar/refmed carbohych·ate into the intesti11e. Early post-prandial sympto1ns it1clude dizziness, faintness, sweating, and a Sl1dden drop in blood pressl1re. Later sympto1ns cat1 occur 72 l1ours after eating including weakness, cold, and faintness associated with l1ypoglycaemia resulting fi·o1n excessive release of insulin it1 response to rapidly absorbed dietaty carbohych·ate. Both early and late symptoms can be co11tt·olled by eating small meals regl1larly, li1niting refmed carbohydrate, and incll1ding small quru1tities of higl1 fiber foods. CamScanner VIII) Gastrectomy and stomach surgery Nutritional management: Diarrhea is relatively common in the first 1-2 months after gastric surgery. Antimotility medication, e.g. codeine phosphate or loperamide hydrochloride, may help. Vomiting of bile and other digestive juices may occur after partial gastrectomy, particularly in the morning. Anti-emetic drugs, e.g. domperidone or n1etoclopranude, may help but some patients require reconstructive surgery to alle,riate the problem. Indigestion may be relie,red by peppermint oil. Foods that exacerbate should be a,roided. CamScanner VIII) Gastrectomy and stomach surgery S11pple111entatio of nutrients is not ro11tinely req11ired by all patients but should be dete11ni11ed on an individ11al basis depending on the patient's 11nderlying disorder, extent of s11rge1y, and oral i11take. Energy and macron11trients : Weigl1t loss may it1dicate an it1adequate intake or a rec1111·ence of rnalignant disease· it1take sl1011ld be assessed a11d, if necessa1y, s11pple1nented. CamScanner VIII) Gastrectomy and stomach surgery Vitamin B12: Prophylactic vitamin B12 supplementation by intramuscular injection is mandato1y follovling total gastrectomy due to loss of stomach-derived intrinsic factor required for absorption. In patients \Vith partial gastrectomy, ·vitamin B 12 absorption test should be checked to identify requirement. Iron arid folate: Regular blood tests are required to identify anaemia and iron and\or folate are supplemented as necessary. Calcium and ·vitrunin D : Bone disease is common after gastrectomy and supplementation may help pre·vent this. CamScanner  IX) Malabsorption Symptoms: Diarrhea, abdominal distension, and flatulence due to intestinal gas production, and weight loss. CamScanner  IX) Malabsorption l\llain causes of malabsorption : Anatomical: St1rgical resection. Ll11ni11al factors: Altered pH, e.g. Zollinger-Ellison syndrorne, bile salt it1st1fficiency, enzy111e inst1fficiency, pancreatic it1st1fficiency, e.g. lipase - la,ctase deficiency. Mucosa.I lllst1fficiency: Villot1s atJ:ophy - Coeliac disease - Crohn's disease. Infection Dtugs: Antibiotics, excessive laxative use. CamScanner  IX) Malabsorption T1·eatment: The underlying cause of malabsorption should be treated wherever possible, e.g. treating infections, prescribing pancreatic lipase in insufficiency, avoiding gluten in coeliac disease. If this cannot be done, the effects of malabsorption can be partially ameliorated through dieta.r y manipt1lation. CamScanner  IX) Malabsorption N t ·itional manage e t: Consideration must be given to tl1e cause of 1nala,bsorptio11 in order to ide11tify tl1e specific sectio11 of the s111all intesti11e that is affected and thus ,:vhicl1 nl1t1ients are likely to be inadeql1ately absorbed, e.g. disaccharides are absorbed in the proxilnal jejlllllnn, vitainin B 12 i11 the ileu111. CamScanner  X) Steatorrhoea Untreated fat 1nalabsorption is potentially ve1y seriol1s becal1se undigested fat f011ns complexes within the gastrointestinal lt1n1en with calciu1n and other minerals preventi11g the1n and a. wide range of other nutrients fro1n being absorbed. If steato1Thoea arises fi·om pancreatic lipase i11sufficiency, this should be remedied by prescribing pancreatic enzyn1es. However, bile inadequacy cannot be so rea,dily treated ancl a low fat diet 1nay be required. CamScanner  X) Steatorrhoea N t1·itional manage ent: Lo"\i\r fat diet: The a111ount of fat tolerated varies bet\:veen individuals and it is recon1I11e11ded that a. very lovv fat diet of 20 g /day is instigated ten1porarily (days 011ly) 1111til sy1npto1ns resolve and then sn1all atnounts of additional dieta1y fat are a.dded to the diet to tolerance. Fat-solt1ble vitrunins, A, D E, and I(: If absorptio11 is in doubt, vitamin stah1s sl1011ld be assessed. Supple111ents shot1ld be given orally or by intrain11sct1lar injection depe11di11g on the degree of 111ala.bsorption. CamScanner  X) Steatorrhoea Nut ~·t·,ona · Inanagelllent: Calciulll Supple1nents : e.g. 1600 1ng daily, sl1ot1ld be gi,,e11 if steato11·hoea is prolo11ged or tl1ere is evide11ce of bo11e tlll1111lllg. Essential fatty acids: Tl1e litnited dietaiy fat consullled sl1ol1ld incll1de s0111e li11ole11ic a11d lir1oleic fatty acids. CamScanner  XI) Lactose intolerance Insufficiency of la.ctase is the 1nost co1nmon cal1se of carbohydrate related n1alabsorption (sucra.se and 111altase deficie11cy is ve1y rare except i11 Greenland). Prin1a1yr: due to autosomal recessive disorder ,¥here la.ctase production is no1111al i11 childre11 and decli11e in older children ai1d ad11lt. Secondary: due to loss of la.ctase prodt1ctio11 as a rest1lt of damage to the intesti11al villi. CamScanner  XI) Lactose intolerance N ti·itional management: This is based on a low lactose or lactose free diet. This is relatively straightforward in a.dults ai1d older children providing that tl1e rest of the diet includes Slifficient ,,ai·iety to n1eet all nutrient 11eeds inclt1ding calcimn. Diet for lactose intolerance Individl1als vary i11 the an1olmt of lactose tl1ey can tolerate ,vithot1t experiencing sy1npto1ns of malabsorptio11 (dia11·hoea., bloati11g, and discomfo1t). CamScanner  XI) Lactose intolerance N ti·itional manage ent: Lactose tolerai1ce may be 1naximized by consl1111ing s1nall amounts of la.ctose in tl1e diet; this allows colonic ba.cteria.to adapt to and metabolize lactose. Dietaiy calcium intake 1nay be co1npromised i11 individ11als avoiding milk and other daily products. This is pa1ticularly a. concern for children, teenagers, pregnant ,vo1nen, and those with a fa111ily history of osteoporosis. Good sol1rces of no11-n1ilk calcil11n incl11de: oily fisl1, e.g. sai·di11es, ,:vhite or browi1 bread, ca.lcilIIn-fo1tified soya chinlcs. CamScanner  XID Crohn's disease (CD) Inflammation can affect any part of the gastrointestinal tract but is most common in the ilea-caecal region of the small intestine and colon. Abdominal pain and diarrhea (,vith mucus and blood) feature. Recurrent episodes of inflammation lead to deep ulceration, strictures, and fistulae. CamScanner  Xlij Crohn's disease (CD) Nut1~it·O n a Inanagelllent: Oral 11utritional supple1ne11ts sl1ot1ld be offered if it1st1fficie11t food is consu1ned. Most co11nnercial products (except po,vders tl1at ai·e 1nixed witl1 1nilk) ai·e low in la,ctose so a,cceptable even if seco11daiy lactose i11tolera11ce is s11spected E11teral feedit1g is tl1e prefe11·ed ro11te if oral it1take is i11adeqt1ate a11d should be considered early before 1111tritio11al depletio11 is allowed to progress CamScanner  Xlij Crohn's disease (CD) N t1 itiona management: 1 Standard micronutrient supplementation should be given. The anti-inflammatory effects of n-3 fatty acids may have a beneficial effect on rem1ss1on. Calcium intake and bone status should be m·onitored in those receiving corticosteroids.,._.; for more severe disease. CamScanner  XII) Crohn's disease (CD) Nutritional management: Elemental (amino acid based) or polymeric (containing ,~vhole protein) diets are less effective than corticosteroids but may have a role in inducing remission in patients ,vith active CD ,vho have a contraindication or preference not to use this medication. Therefore, elemental or polymeric diets are considered appropriate adjunctive therapy. Elemental diets are less palatable than polymeric diets and consideration should be given to compliance if patients are ad~.ris.e d to consume these over a long period. Total parenteral nutrition is an appropriate adjunctive therapy in patients ,vith fistulae. CamScanner  XIII) Disorders of the colon ! Constipation Nutritional n1anagement: Increasing dietary fiber and taking an adequate fluid intake. CamScanner  XIII) Disorders of the colon ! Hae111011·hoids Nutritional 1nanagen1ent: Increasit1g fiber intake is usefi1l for softening faeces, relieving constipation, and tl1us reducing straining. Fiber st1pple1nentation reduces episodes of bleeding and cliscomf01t it1 patients vvith internal haen1on·hoids although tills 111ay take tip to 6 weeks; it does not in1prove external (prolapsed) haen1011·hoids. Cereal fiber is 1nost effective in increasing stool \¥eight a11d bulk-f011ning. Laxative, ispagh11la husk, 111ay help. CamScanner  Gall bladder disorders ! Gallstones , Risl< fa.ctors for cholesterol gallstones: ~ Age > 40 years. Female. Genetic variation. 1' Fat, J fiber diet. Obesity Yo-yo dieting (repeated cycles of losing and re- gaining vveight. CamScanner  XIV) Gall bladder disorders ! Gallstones ► Preventing gallstones: Reduction of excess body weight usi11g moderate energy restrictio11 (ve1y lovv calorie diet may exacerbate bile saturation). Eat regularly to 111it1itnize bile stasis which accornpanies fasting. L,! Eat breakfast 011 rising ( cholesterol co11centrations are l1ighest in bile prodt1ced ove111igl1t). Lovv fat diet reduced gall bladder contractions a11d redt1ced pain. CamScanner Drug & Nutrient Interactions in GIT diseases CamScanner Drug & Nut1~ient Inte1~actions in GIT diseases F oocl cai1: Speed 11p or slow down the action of a. 1nedicatior1. Itnpair abso1ptio11 of vitai11i11s a11d n1it1erals ir1 tl1e body. Stitnula.te or suppress tl1e appetite. Alter l1ow nu1l:ie11ts are usecl ir1 tl1e body. Herbs a11d traditio11al Illedica.tions can also it1teract especially ,¥itl1 ru1ticoagt1la11ts and cru:diovasculai· 1neclicatio11s. CamScanner D1~ug & Nut1~·ent Inte1~actions in GIT diseases Factors Affecting the Extent of Interactions : Characteristic & Dosage of the Drug Age, size and disease state. Type offood - nutrient. Titne of feeding and administration of tl1e medication. CamScanner  Drugs Affecting Nutritional Status D1ug-11t1trie11t interaction: tl1e result of tl1e actio11 betwee11 a d1ug a11d a_ 11utrie11t tl1at would 11ot happen ,¥ith tl1e 11l1trie11t or the drug alo11e. F ood-d1ug interaction: a broad te11n tl1at includes chug-1111trie11t i11teractio11s a11d the effect of a. 1lledicatio11 01111t1tritio11al status. CamScanner  Drugs Affecting Nutritional Status Cl1ange i11 taste & smell - dysge11sia Gastrointestinal effects o affect peristalsis: 11101plline, a11tibiotics o cal1se bleedit1g: NSAID - ibltprofen o anorexia: Dextoampheta11U11e metl1ylpl1e11idate. Affect appetite: Megestrol and ch·onabinol. I11crease or decrease glucose levels o JJred11isone i o antidiabetics -Acarbose Metfo11nit1 it1sl1lin ! CamScanner  Inte1·actions with P1·oton Pump Inh ·bito1·s (PPis) PPis work best ,vhen taken 011 an ernpty sto1nacl1. People sl1ot1ld take 1nost PPis at least a l1alf-hot1r before the first meal of the day. They should wait at least an l1our after taking Esomeprazole (Nexiurn) before eating. People sl1ot1ld avoid foods that can trigger acid reflux. This helps them receive the fi1ll heali11g benefit of PPis. PPis and Alcohol: Alcol1ol increases sto111acl1 acid production. It also it1·itates tl1e sto1nacl1 li11ing. Tliis combinatio11 can \Vorsen lilcer S)'tnptoms. fu sorne patients, alcohol can also slo,v ulcer healing. CamScanner  Inte1·actions with Proton Pump Inhibito1·s (PPis) The Most Common Acid-Reflux Triggers Include: Cit11.1s fi1.1its Peppe1llllnt Caffeinated drinks (i.e. coffee and soda) Chocolate Sugary foods Spicy foods Reel and processed 1neats Tomatoes and tomato-based prod11cts Higl1-fat or greasy (fi·ied) foods CamScanner  Interactions with Antacids Take anta,c ids witl1 food, a.s tl1is ca11 1nake tl1eir effect last lo11ger. Caffeine and alcol1ol ca11 ti·igger the productio11 of 1nore stolllacl1 a.c id, 1nakit1g heaitbu111 ,:vorse. Too liluch nlllk and dairy products with anta.c ids can lead to '1nilk-alkali syndro1ne' or l1ypercalca.elllia. (l1igl1 levels of ca.lciu1n it1 the blood). Sy111pto1Ils a1·e a11 i11creased risk of bone fi_.actures a11d kid11ey sto11es, weigl1t loss, ,,01nitit1g, co11stipation, ,veakness, tired11ess and cl1anges in 1nental status. CamScanner  Inte1 actions with Antacids 1 Orange juice with antacids containing aluminiu1n can increase the absorption of the aluminit1m. The concomitant of alwninum-contai11ing products ( e.g., antacids a11d phosphate binders) and citrates may significantly increase serum aluminum concentrations, resulting in toxicity. Citrates or citric acid are contained in nt1merous soft drinks, citrus fruits, juices, and effervescent and dispersible drug fonnulations. CamScanner A11ti-Diar1~heal (lope1·amide) d1·ug inte1·actions Alcohol can increase the nervous system side effects of loperan1ide such as dizziness, drowsiness, and difficulty concentrating. CamScanner  Mitronidazole Alcohol n1ay result i11 a disulf1ran1-like reaction in so1ne patients. There l1ave been a few case reports involving n1etrni~azole, althot1gh data overall are not convrnc111g. The prestnned 1nechanisn1 is inhibition of aldehyde dehydrogenase (ALDH) by 111etronidazole in a 111anner si111ilar to disulf1ra1n. Following ingestion of alcohol. inlllbition of ALDH rest1lts in increa.sed.,, conce11trations of a.cetaldehyde, the acc1lll111lation of ,vhich can produce an 1111pleasant pl1ysiologic respo11se refe11·ed to as tl1e 'disulf1ra1n reactio11'. CamScanner  Mitronidazole Symptoms include flushing, throbbing in head and neck, throbbing headache, respiratory difficulty, nausea, vomiting, sweating, thirst, chest pain, palpitation, dyspnea, hyperventilation, tachycardia, hypotension, syncope. CamScanner  Ciprofloxacin ,C affeine-containing Foods/Beverages: Reduction or li1nitatio1i of the caffei1ie dosage in 1nedications and limitatio1i of caffeitie in beverages arid food may be necessa1y d11ring concu11·e1it ciprofloxaci1i therapy. Ciprofloxacin is a CYP 1A2 itihibitor arid caffeitie is a. CYP 1A2 substrate. Ciprofloxa.c in can clecrease tlie clearance of caffeine. Caffeine toxicity may occ11r and can ma11ifest as riausea, vomiti1ig, anxiety, tacliycardia, or seizures. CamScanner  Ciprofloxacin ,Calcit1m-containing foods : The absorption of oral ciprofloxacin may be decreased if taken ,vith calcium-containing foods or beverages as it binds to the calcium in the calcium supplements, rendering the drug unavailable to the body. CamScanner  Ciprofloxacin Multivitainins vvitl1 lilinerals: Prod11cts that contair1 n1agnesi111n~ alulllinmn, calciulll, iron, a11d/or otl1er 1ni11erals lllay interfere with tl1e abso1ptio11 of ciprofloxacin it1to the bloodstreai11 a11d reduce its effecti\.reness. If possible, it tnay be best to a.v oid takiI1g 1nultivita1nin witl1 1ninerals while beir1g treated witl1 ciprofloxa.cit1. Otherwise, ciprofloxacir1 should be take11 eitl1er 2 to 4 l1011rs before or 4 to 6 l1ours after the lllultivita111in with n1inerals dose. CamScanner CamScanner