consistency-modified & other diets for upper gi disorders

Nutrition & Diet Therapy (7th Edition)

Consistency-Modified & Other Diets for Upper GI

DisordersChapter 17


Gastrointestinal Disorders

• Significant reason for hospitalization & visits to health practioners annually

• Diagnosis may be difficult– GI complaints may not be associated with

physical abnormalities– Detailed evaluation of symptoms &

responses to dietary adjustment necessary

• GI complications frequently accompany other illness


Modifications in Food Texture& Consistency

• Modifications in food texture & consistency may be helpful for people with difficulty chewing or swallowing

• Modifications may also be necessary for patients as they resume foods orally

• Diets can be altered as patient’s condition changes


Modifications in Food Texture and Consistency

• Mechanically altered diets– Routinely prescribed for individuals with

chewing or swallowing difficulties– Pureed diet: contains foods pureed to

pudding-like consistency– Mechanical soft diet: contains ground or

minced foods or moist, soft-textured foods– Blenderized diet: includes foods from all food

groups, often with added liquid


Liquid Diets• Clear liquid diet

– Requires minimal digestion; easily tolerated– Consists of clear fluids & foods that are liquid at room

temperature; leaves little intestinal residue– Limited energy & nutrient content—must be

supplemented if used for more than 1-2 days

• Full liquid diet– Includes milk & other opaque liquids– May be transitional diet between clear liquid & solid

foods

• Diet progression: change in diet to adapt to patient’s tolerance to foods


Conditions Affecting the Mouth& Esophagus

• Dry mouth (xerostomia)– Causes

• Reduced salivary flow• Autoimmune diseases• Radiation therapy• Mouth breathing

– Consequences• Impairment of health & quality of life• Associated with increased plaque, tooth decay, gum

disease, mouth infections• Interferes with speech• Makes chewing & swallowing more difficult• Discomfort of denture fit; development of ulcerations

in mouth


Conditions Affecting the Mouth & Esophagus, con’t

• Dysphagia– Causes

• Neurological diseases & disorders• Surgical procedures involving head & neck• Physiological or anatomical abnormalities restricting

movement of food in the throat or esophagus

– Types• Oropharyngeal dysphagia: inability to transfer food

from the mouth & pharynx to the esophagus; often caused by neurological or muscular disorder

• Esophageal dysphagia: inability to move food through the esophagus; usually caused by obstruction or motility disorder


Dysphagia con’t

– Complications• Aspiration• Airway obstruction• Choking• Respiratory infections• Reduced food consumption, malnutrition & weight

loss

– Dietary intervention• Careful assessment of swallowing abilities• Modification of physical properties of foods &

beverages• Alternative feeding methods


National Dysphagia Diet(Table 17-4)

• Level 1: Dysphagia Pureed– Foods pureed, homogeneous & cohesive– Diet for patients with moderate-to-severe dysphagia &

poor oral or chewing ability

• Level 2: Dysphagia Mechanically Altered– Foods moist & soft textured; foods easily form a bolus– Diet for patients with mild-to-moderate dysphagia;

some chewing ability required

• Level 3: Dysphagia Advanced– Foods moist & in bite-sized pieces when swallowed– Individuals using diet need to tolerate mixed food

textures– Diet for patients with mild dysphagia


Dysphagia Diet(con’t)• Liquid Consistencies -Thin=watery

- Nectarlike=fluids thicker than water-Honeylike=fluids that can be eaten with a spoon, don’t hold their shape-Spoonlike=Thick fluids that hold their shape

– Feeding strategies• Depends on nature of swallowing problem• Strengthening exercises of jaws, tongue or larynx• Changing position of head & neck while eating• Learn new methods of swallowing

– Speech & language therapists often responsible for teaching patients techniques & strategies to improve feeding


Conditions Affecting the Mouth & Esophagus con’t

• Gastroesophageal Reflux Disease (GERD)– Reflux of stomach acid into esophagus (& mouth)– Results in frequent discomfort & may cause tissue

damage– Often referred to as heartburn or acid indigestion– Causes

• Weakening of lower esophageal sphincter• Medical conditions that interfere with sphincter’s

mechanism or prevent rapid clearance of acid from the esophagus

• High rates of GERD associated with pregnancy, asthma, hiatal hernia


GERD (con’t)

• Consequences– Damage to esophageal

lining—resulting in reflux esophagitis

– Esophageal ulcers– Esophageal stricture– Painful swallowing– Pulmonary disease (if

gastric contents are aspirated into lungs)

– Chronic reflux: Barrett’s esophagus

• Treatment– Aimed at alleviation of

symptoms & facilitating healing of damaged tissue

– Medications• Proton-pump inhibitors• Histamine-2 receptor

blockers


Conditions Affecting the Stomach

• Dyspepsia (indigestion)– General discomfort in

upper abdominal region– Often associated with

specific foods– Symptoms

• Stomach pain• Heartburn• Fullness, bloating• Nausea

– Symptoms may indicate more serious condition, including GERD or peptic ulcer

– Causes• Difficult to pinpoint

exact cause• Complete exam

necessary if symptoms severe

• Medical conditions • Medications & dietary

supplements• Intestinal conditions

can mimic: irritable bowel syndrome, lactose intolerance

• Potential food intolerances


Dyspepsia (con’t)

– Potential food intolerances• Not substantiated by research• Individual responses to certain foods & spices

– Coffee– Spicy foods– High-fat meals

– Minimizing symptoms• Consume small meals with well-cooked foods• Avoid heavy seasoning• Consume meals in relaxed atmosphere


Conditions Affecting the Stomach con’t

• Nausea & vomiting– Accompany many

illnesses & are common side effects to medications

– Prolonged vomiting can cause fluid & electrolyte imbalance

– Chronic vomiting may reduce food intake, leading to malnutrition & nutrient deficiencies

– Timing of vomiting gives clues to cause

– Treatment• Diagnose & treat

underlying disorder• Restoring hydration• Taking medication(s)

with food• Symptomatic

treatment with medications that suppress nausea & vomiting

Intractable vomiting: Vomiting that resists

usual treatment


Nausea & vomiting con’t

– Dietary interventions—may prevent or improve nausea

• Eating & drinking slowly• Eating small meals that do not distend the stomach• Drinking clear, cold beverages such as carbonated

drinks or fruit juices• Selecting foods that reduce nausea, such as dry,

salty foods (crackers, pretzels), foods at room temperature

• Some individuals have strong food aversions & tolerances vary considerably


Conditions Affecting the Stomach con’t

• Gastritis– General term referring to

inflammation of stomach mucosa

– Causes• Infection• Irritating substances• Diseases & treatments

that damage stomach lining

• Acute erosive gastritis: associated with hemorrhage, tissue erosion or ulcers

– Complications• Disruption of gastric

secretory functions• Impaired absorption of

nonheme iron & vitamin B12

• Pernicious anemia– Dietary interventions

• Dependent on symptoms• Avoidance of irritating foods

& beverages• Avoidance of food intake if

food consumption causes increased pain or nausea & vomiting

• Nutrition support if food intolerance persists


Conditions Afffecting the Stomach con’t

• Peptic ulcer disease– Results from destructive

effects of hydrochloric acid & pepsin

– Causes• Helicobacter pylori

infection• Use of NSAIDs• Disorders that cause

excessive acid secretion

– Increased risk from cigarette smoking, emotional stress & genetic factors

• A peptic ulcer damages mucosal tissue & may cause pain & bleeding


Peptic ulcer disease (con’t)

– Signs & symptoms• May be asymptomatic or cause only mild discomfort• Ulcer “pain” similar to hunger pain—gnawing or

burning sensation in stomach region• Symptoms aggravated by food

– Complications• Gastrointestinal bleeding• Perforation of stomach or duodenum• Gastric outlet obstruction


Peptic ulcer disease (con’t)

– Drug therapy-first line of treatment• Goals: relieve pain, promote healing & prevent

recurrence• Antibiotics to eradicate H. pylori• Discontinuation of aspirin & other NSAIDs• Antisecretory drugs—proton-pump inhibitors, H2

blockers, antacids

– Diet considerations• Only if symptoms are affected by foods; then

individualized• Avoidance of foods that irritate GI lining: alcohol,

coffee & caffeine-containing beverages, spicy foods• Small meals


Gastric Surgery• Indications for surgery

– Popular treatment for obesity– Treatment of peptic ulcers that resist drug therapy– Correction of ulcer complications– Treatment of stomach cancer

• Gastrectomy – Surgical removal of diseased portions of the stomach

(partial gastrectomy) or entire stomach (total gastrectomy)

– Other gastric resection procedures to treat complications of ulcers

• Vagotomy• Pyloroplasty


Gastrectomy (con’t)

– Postgastrectomy diet• All foods & fluids withheld until some healing has

occurred• Immediately after surgery: IV fluids, with careful

monitoring of fluid balance• 24-48 hours after surgery: ice chips or small sips of

water• 4-5th day after surgery: liquids, progressing to solid

foods when tolerated; tube feedings if unable to progress to solid foods

• Adjustments influenced by size of remaining stomach & rapid gastric emptying that results



– Dietary adjustments

• Smaller stomach limits meal size; affects food tolerance because of potential for dumping syndrome

• Several small meals & snacks containing only one or two food types

• Inclusion of protein, fats, complex carbohydrates• Slow progression to 5-6 meals per day• Avoidance of sugars & sweets• Avoidance of milk products if lactose intolerant• Addition of fiber to delay stomach emptying and reduce

diarrhea• Some patients experience problems with fatty foods, highly

spiced foods, carbonated beverages, caffeine-containing beverages, alcohol, extreme temperatures, peppermint & chocolate



– Complications & nutrition status•Substantial weight loss•Fat malabsorption•Bone disease•Anemia


Gastrectomy con’t

• Dumping syndrome– Common complication of gastrectomy &

gastric bypass surgery– Group of symptoms resulting from

abnormally rapid gastric emptying– Hypertonic gastric contents rush into

small intestine more quickly after meals, resulting in unpleasant effects

– Symptoms of dumping syndrome may occur within 30 minutes of meal


Gastric Surgery con’t• Bariatric surgery

– Surgical treatment for severe obesity– Gastric bypass surgery (roux-en-Y) popular option

• Creation of small gastric pouch• Reduces gastric capacity, restricting meal size• Also creates bypass of part of small intestine, restricting

absorptive capacity• Helps to achieve long-term weight loss

– Dietary guidelines after bariatric surgery• Gradual expansion of gastric pouch to increase capacity to

approximately 1 cup; initially only few tablespoons• Initially post-op: ice chips & sips of water• Progress to liquid diet for first 1-2 weeks (small, frequent

meals)• Followed by pureed foods, progressing to soft, then regular

foods• Some foods difficult to manage


Bariatric surgery (con’t)

– Patient education & counseling critical for weight loss & management

• Food portion control to avoid dumping syndrome & to maintain weight loss

• Elements of healthy diet• Foods that may cause discomfort, vomiting or dumping• Dietary supplements

– Post-surgical concerns• Dumping syndrome• Fat malabsorption• Multiple nutrient deficiencies• Rapid weight loss increasing risk of gallbladder disease• Plastic surgery to remove extra skin after weight loss


Nutrition in Practice—Helping People with Feeding Disabilities

• Multitude of coordinated motions required for eating & drinking

• Injury or disability can interfere with any of these movements, leading to feeding problems & inadequate food intake

• Difficulties that affect feeding can also lower food intake, leading to malnutrition & weight loss

• Feeding difficulties lead to problems with independence

• Problems affect both the individual & family— affecting family life


Inability to grasp

• Special equipment to assist with feeding– Adaptive devices make remarkable difference

in person’s ability to eat independently; usually assessed by the Occupational Therapist

• Utensils• Plates• Cups• Specialized chairs & bolsters

– If food consumption remains inadequate, tube feedings may be required

consistency-modified & other diets for upper gi disorders

Documents

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