Download Chapter 17

Consistency-Modified &
Other Diets for Upper GI
Disorders
Chapter 17
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
Conditions Affecting the Mouth
& Esophagus
• Dry mouth (xerostomia)
– Causes
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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
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
Dysphagia con’t
– Complications
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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
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
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
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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
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
• 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
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Stomach pain
Heartburn
Fullness, bloating
Nausea
– Symptoms may indicate
more serious condition,
including GERD or
peptic ulcer
Nutrition & Diet Therapy (7th Edition)
– 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
Nutrition & Diet Therapy (7th Edition)
Conditions Affecting the
Stomach con’t
• Nausea & vomiting
– Accompany many
– Treatment
illnesses & are common
• Diagnose & treat
side effects to
underlying disorder
medications
• Restoring hydration
– Prolonged vomiting can
• Taking medication(s)
cause fluid & electrolyte
with food
imbalance
• Symptomatic
– Chronic vomiting may
treatment with
reduce food intake,
medications that
leading to malnutrition
suppress nausea &
& nutrient deficiencies
vomiting
– Timing of vomiting
gives clues to cause
Intractable vomiting:
Vomiting that resists
usual treatment
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
Conditions Affecting the
Stomach con’t
• Gastritis
– General term referring to – Complications
inflammation of stomach
• Disruption of gastric
mucosa
secretory functions
• Impaired absorption of
– Causes
• Infection
• Irritating substances
• Diseases & treatments
that damage stomach
lining
• Acute erosive gastritis:
associated with
hemorrhage, tissue
erosion or ulcers
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
• 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
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
Gastric Surgery
• Indications for surgery
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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
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
Gastrectomy (con’t)
– 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
Nutrition & Diet Therapy (7th Edition)
Gastrectomy (con’t)
–Complications & nutrition status
•Substantial weight loss
•Fat malabsorption
•Bone disease
•Anemia
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
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
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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 & Diet Therapy (7th Edition)
Nutrition & Diet Therapy (7th Edition)
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
Nutrition & Diet Therapy (7th Edition)
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
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Utensils
Plates
Cups
Specialized chairs & bolsters
– If food consumption remains inadequate, tube
feedings may be required
Nutrition & Diet Therapy (7th Edition)