Chapter 17 Nutrition and Upper Gastrointestinal Disorders

1717
Nutrition and
Upper
Gastrointestinal
Disorders
Copyright © 2017 Cengage Learning. All Rights Reserved.

© Cengage Learning 2017
Conditions Affecting the Mouth
and Esophagus
• Dry mouth (xerostomia)
– Caused by reduced salivary flow
• Side effect of many medications; associated with a
number of diseases and disease treatments
– Ways in which dry mouth impairs health
• Difficulty swallowing, mouth infections, dental
diseases, increased malnutrition risk, etc.
• How can dry mouth be managed? (Table 17-1)

and Esophagus (cont’d.)
• Dysphagia
– Processes involved in swallowing
• Oropharyngeal phase
– Mouth and tongue muscles propel the food bolus through
the pharynx and into the esophagus
– Food entry into nasal cavity and trachea prevented
• Esophageal phase
– Peristalsis forces the bolus through the esophagus
– Lower esophageal sphincter relaxes to allow bolus
passage into the stomach

and Esophagus: Dysphagia (cont’d.)
• Categories of dysphagia
– Oropharyngeal dysphagia
• Inhibits the transfer of food from the mouth and
pharynx to the esophagus
• Typically a neuromuscular disorder
– Esophageal dysphagia
• Interferes with the passage of materials through
the esophageal lumen and into the stomach
• Obstruction in the esophagus or a motility disorder

Insert image of second row/block of
Table 17-2

• Complications of dysphagia
– What are various complications that may
accompany dysphagia?
• Nutrition intervention for dysphagia
– Physically modified foods and beverages
– Dietary plan requires frequent reassessment
– National Dysphagia Diet (Table 17-3)

• Food properties and preparation
– Food textures and consistencies chosen or
altered to make them easier to swallow
– Solid foods may be pureed, mashed, ground,
or minced
– Box 17-4: tips to improve acceptance
• Properties of liquids: thin, nectarlike,
honeylike, and spoon-thick

• Alternative feeding strategies for
dysphagia
– Change head and neck position while eating
and drinking
– Strengthen the jaws, tongue, or larynx
(through exercises)
– Learn new swallowing methods

and Esophagus (cont’d.)
• Gastroesophageal reflux disease (GERD)
– Frequent reflux (backward flow) of the
stomach’s acidic contents into the esophagus
– Heartburn or acid indigestion
• Causes of GERD
– Weak lower esophageal sphincter muscle
– Predisposing factors: high stomach
pressures; inadequate acid clearance from
esophagus

and Esophagus: GERD (cont’d.)
• Causes of GERD
– High rates of GERD associated with obesity,
pregnancy, and hiatal hernia

The Upper GI Tract, Acid Reflux, and
Hiatal Hernia

• Consequences of GERD
– Reflux esophagitis
– Esophageal ulcers
– Dysphagia
– Pulmonary disease (due to aspiration)
– Barrett’s esophagus
– Mouth damage

• Treatment of GERD
– Alleviate symptoms and facilitate healing
– Acid-suppressing drugs: proton-pump
inhibitors, histamine-2 receptor blockers
– Lifestyle changes (Box 17-6)
– Surgery: fundoplication, esophageal dilation
– Example: Box 17-7 (case study)

Conditions Affecting the Stomach
• Dyspepsia: symptoms of pain or
discomfort in the upper abdominal area
– Causes of dyspepsia
• Various medical problems: foodborne illness,
GERD, peptic ulcers, gastric motility disorders,
gallbladder or pancreatic disease, tumors
• Some chronic diseases, e.g., diabetes mellitus
• Medications, dietary supplements
• Other conditions

Conditions Affecting the Stomach:
Dyspepsia (cont’d.)
• Potential food intolerances
– Consume small, frequent meals
– Avoid fatty or highly spiced foods
– Avoid the specific foods believed to trigger
symptoms
• Bloating and stomach gas
– Avoid air-swallowing practices: gum chewing,
smoking, rapid eating, drinking carbonated
beverages, and using a straw

(cont’d.)
• Nausea and vomiting
– What health problems occur with prolonged
vomiting?
– Vomiting with abdominal pain: GI disorder or
obstruction
– Vomiting without abdominal pain:
medications, foodborne illness, pregnancy,
motion sickness, neurological disease, etc.

Nausea and Vomiting (cont’d.)
• Treatment of nausea and vomiting
– Find and correct the underlying cause
– Restore hydration
– Take medication with food
– May need suppressive medication
– What may be necessary in cases of
intractable vomiting?

Nausea and Vomiting (cont’d.)
• Dietary interventions
– Small meals
– Beverages between meals
– Dry, starchy foods or cold/room temperature
foods may be better tolerated
– Fatty, spicy, strong-smelling, or hot foods may
be less tolerated

(cont’d.)
• Gastritis: inflammation of the stomach
mucosa
– Acute cases
• Caused by irritating substances or treatments that
damage the gastric mucosa
– Chronic cases
• Caused by long-term infections: Helicobacter pylori
• Autoimmune disease
• Nonsteroidal anti-inflammatory drugs (NSAIDs)

Gastritis (cont’d.)
• Complications of gastritis
– Disrupted gastric secretory functions
• Hypochlorhydria or achlorhydria can impair
absorption of nonheme iron and vitamin B12
• Pernicious anemia (reduces intrinsic factor) results
in macrocytic anemia of vitamin B12 deficiency
• Dietary interventions for gastritis
– Avoid irritating foods and beverages
– Iron and vitamin B12 supplements

(cont’d.)
• Peptic ulcer disease
– Peptic ulcer: open sore in the GI mucosa
– H. pylori infection
• 30% to 60% of patients with gastric ulcers
• 70% to 90% of patients with duodenal ulcers
– NSAIDs: damage the GI lining
– Smoking and psychological stress can
increase risk

Peptic Ulcer Disease (cont’d.)
• Effects of psychological stress
– May contribute to risk by producing hormonal
or behavioral changes
• Symptoms of peptic ulcers
– Vary: asymptomatic or mild discomfort;
hunger pain or burning pain in the stomach
– Tend to go into remission and recur every few
weeks or months

• Complications of peptic ulcers
– GI bleeding
– Stomach or duodenum perforations
– Ulcer penetration into an adjacent organ
– Gastric outlet obstruction
• Drug therapy for peptic ulcers
– What are the goals of ulcer treatment?

• Drug therapy for peptic ulcers
– Discontinue aspirin and other NSAIDs
– Antibiotics for H. pylori
– Antisecretory drugs
• Nutrition care for peptic ulcers
– What are the goals of nutrition care for peptic
ulcers?
– What are typical interventions?

Gastric Surgery
• Gastrectomy
– Partial gastrectomy
• Only part of the stomach is removed
• Remaining portion is connected to the duodenum
or jejunum
– Total gastrectomy
• Entire stomach removed
• Esophagus connected directly to the small
intestine

Gastrectomy Procedures

Gastric Surgery: Gastrectomy (cont’d.)
• Nutrition care after gastrectomy (Table 17-
6)
– What are the primary goals of nutrition care
after a gastrectomy?
– Feeding progression:
• NPO with intravenous feeding
• Water and broth (oral fluids)
• Liquid meals (with no sugar)
• Solids with one or two foods at a time

• Nutrition care after gastrectomy
– Dietary measures determined by size of
remaining stomach, stomach emptying rate
– As many as 5-8 small meals per day
• Protein food in each meal
– Avoid sweets and sugars (can potentiate
dumping syndrome)
– Liquids restricted during meals

• Dumping syndrome: symptoms caused by
rapid gastric emptying
– Flow from stomach to duodenum normally
controlled by pyloric sphincter
– After some types of gastric surgery, stomach
emptying is no longer regulated
• Hyperosmolar chyme rushes into small intestine
– Box 17-11 offers symptom reduction tips

• Nutrition problems following a gastrectomy
– Food avoidance; substantial weight loss; and
eventually, malnutrition
– Fat malabsorption
– Bone disease: osteoporosis and osteomalacia
– Anemia

Gastric Surgery (cont’d.)
• Bariatric surgery: most effective and
durable treatment for morbid obesity
– Candidates
• BMI >40
• BMI 35 to 40 accompanied by severe weight-
related problems
• Patient should have attempted a variety of
nonsurgical weight-loss measures

Gastric Surgery: Bariatric Surgery
(cont’d.)
• Bariatric surgical procedures
– Gastric bypass: small gastric pouch
constructed; connected directly to the jejunum
– Gastric banding: inflatable band placed
around uppermost portion of the stomach
– Sleeve gastrectomy: large portion of stomach
removed, leaving narrow tube (3-5 oz.)
• Can be converted to gastric bypass
– How do these surgeries compare?

Surgical Procedures for Severe Obesity

(cont’d.)
• Nutrition care after bariatric surgery
– Objectives:
• Maximize and maintain weight loss
• Ensure appropriate nutrient intakes
• Maintain hydration
• Avoid complications
– Diet progression similar to postgastrectomy
– Small portions of food; liquids separately

(cont’d.)
• Nutrition care after bariatric surgery
– Protein: 1.0 to 1.5 g/kg IBW/day
– Vitamin and mineral supplementation
• After bypass, additional B12, D, calcium, iron
– Avoid foods that may obstruct gastric outlet
– Control food portions, avoid high-sugar foods,
consume liquids between meals
– Box 17-14: behavior change strategies

(cont’d.)
• Postsurgical concerns
– Common complaints
• Nausea, vomiting, and constipation
– Long-term complications (after bypass)
• Fat malabsorption, bone disease, and anemia
– Rapid weight loss
• Increases risk of gallbladder disease
• Leaves excess skin that may need to be removed

Nutrition in Practice:
Nutrition in Oral Health
• Dental caries development
• Cariogenic and anti-cariogenic foods
• Periodontal disease
• Conditions that increase risk of oral health
problems
– Diabetes mellitus, HIV/AIDS, oral cancers
• Role of dental bacteria in chronic disease
– Heart disease, diabetes, respiratory illnesses

Chapter 17 Nutrition and Upper Gastrointestinal Disorders

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