Nutrition for Patients
with Upper
Gastrointestinal
Disorders
Dr. Manar Abu-abbas
Chapter 17
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutrition therapy is used in the treatment of many
digestive system disorders
– Some diet therapy is only supportive
– Some diet therapy is cornerstone of
treatment
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
General Assessment
• Nausea, vomiting, diarrhea, heartburn, anorexia, early satiety,
difficulty in chewing & swallowing
• Changes in eating; pattern & frequency
• Weight loss, aspiration, diarrhea
• Food allergies
• Adequate intake according to My Plate including fluids
• drugs, tobacco, caffeine
• Nutritional supplements & herbs
• Willing to change
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Disorders That Affect Eating
Anorexia
– Common symptom
– Side effect of certain drugs
– Emotional issues; fear, anxiety,
depression
– Aim of nutrition therapy is to
stimulate the appetite to
maintain adequate
nutritional intake
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interventions (Anorexia)
• Serve food attractively, if decreased ability to taste is
contributing to anorexia, enhance food flavors
• Schedule procedures and medications when they are least
likely to interfere with meals
• Control pain, nausea, or depression with medications
• Provide small frequent meals
• Withhold beverages for 30 minutes before and after meals
• Offer liquid supplements between meals for additional
calories and protein if meal consumption is low
• Limit fat intake if fat is contributing to early satiety
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nausea and vomiting
Related to:
o A decrease in gastric acid secretion
o A decrease in digestive enzyme activity & GI motility
o Bacterial and viral infection & gastric irritation
o Increased intracranial pressure & equilibrium imbalance
o Liver, pancreatic, and gallbladder disorders
o Pyloric or intestinal obstruction
o Drugs
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Interventions (Nausea and vomiting)
– Short-term concern is fluid and electrolyte balance
– Prolonged concern is dehydration and weight loss
o Food is withheld until nausea subsides
o If patient is ready to eat; clear liquids are offered and
progressed to a regular diet as tolerated
o Small meals of low fat & easily digested carbohydrates
o Eat slowly and not to eat if nauseated
o Good oral hygiene
o Limit liquids with meals & spicy food
o Serve foods at room temperature
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Dysphagia
– Impairments in swallowing
– Aging causes natural changes in the ability to swallow
– Mechanical causes include obstruction, inflammation, edema,
and surgery of the throat
– Neurologic causes include myasthenia gravis, cerebrovascular
accident, traumatic brain injury, cerebral palsy, Parkinson’s
disease, and multiple sclerosis
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nutrition therapy
Goal is to modify the texture of
foods and/or viscosity of liquids to
enable the patient to achieve
adequate nutrition and hydration
while decreasing the risk of
aspiration
–Moist, semisolid foods are easiest to
swallow
Solid foods may be mashed or pureed, and thin liquids may
be thickened to facilitate swallowing & sometimes enteral
nutrition may be necessary.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Feeding techniques may be used to facilitate
safe swallowing:
• Serve small, frequent meals
• Rest before mealtime, Postpone meals if the patient is fatigued.
• Instruct the patient to think of a specific food or use candy to
stimulate salivation.
• Reduce distractions at mealtime so that the patient can focus
on swallowing; allow at least 30 minutes for eating.
• Upright or high Fowler’s position & tilt the head forward to
facilitate swallowing.
• Encourage small bites and thorough chewing.
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Gastroesophageal reflux disease
– Caused by an abnormal reflux of gastric contents into
the esophagus related to an abnormal relaxation of
the lower esophageal sphincter
– Other contributing factors
o Increased intra-abdominal pressure
o Decreased esophageal motility
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Avoid:
1.Large meals
2.Bending over or lying down for 3 hours after meals
3.Heavily spiced & fatty food
4.Wearing tight-fitting clothing
5.Coffee, pepper, chocolate, peppermint
Increase fibers
Anti-reflux medications
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Peptic ulcer disease
– Approximately 15% of ulcers occur in the
stomach and the remaining 85% are in the
duodenum
– H. pylori infection
– Second leading cause of peptic ulcers is
the use of nonsteroidal antiinflammatory
drugs (NSAID)
– Pain from duodenal ulcers may be relieved
by food
– Pain from gastric ulcers may be aggravated
by eating
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
– Long-term use of medications to decrease gastric acid
production may impair the absorption of calcium, iron,
and vitamin B12.
– Pain, or loss of appetite may impair intake and lead to
weight loss
– Iron-deficiency anemia can develop from blood loss
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
– No evidence that diet causes peptic ulcer disease or
speeds healing; Eating spicy food does not cause ulcers.
– Some evidence suggests that a high-fiber diet, especially
soluble fiber, may reduce the risk of duodenal ulcer
– Nutrition intervention may play a supportive role in
treatment by helping to control symptoms
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
• Strategies that may help
o Avoid foods that stimulate gastric acid
secretion, namely coffee, alcohol, and
pepper
o Avoid eating 2 hours before bed
o Avoid individual intolerances
Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
