Nutrition: Gastrointestinal Disorders
Jerome Cuenco, MSN
BIO3450: Nutrition for Disease Prevention & Management
Contents/Learning Objectives
Anti-inflammatory Diets
Esophageal Disorders
Stomach Disorders
Intestinal Disorders
Anti-inflammatory Diets
Because of the health benefits of a diet that reduces
inflammation, two diets have been studied to have the most
evidence for their protective qualities:
Mediterranean diet
Fruits, vegetables, whole grains, legumes, herbs, spices
Fish, poultry, red wine
DASH (Dietary Approaches to Stop Hypertension)
Diet
Fruits, vegetables, whole grains, fiber-rich foods
Low-fat dairy products
These diets include Omega-3 fatty acids, found in salmon,
tuna, mackerel, sardines
Extra-virgin olive oil is also very good in reducing
inflammation
Esophageal Disorders
Dysphagia
Swallowing involves the oral preparation and
transit (chewing), followed by the involuntary
movements of the pharyngeal and esophageal
transit (swallowing)
Any disorder affecting any of these stages may
require specific nutrition interventions
Symptoms of Dysphagia:
Pain while swallowing, inability to
swallow, coughing, gagging while
swallowing
Sensation of food getting stuck in the
throat or chest
Drooling, hoarseness, regurgitation,
heartburn
Long term: weight loss
Patients would be put on a Dysphagia Diet
(pureed, mechanically altered, advanced
diet)
Esophageal Disorders
Gastroesophageal Reflux Disorder
(GERD)
Heartburn - acid refluxes from stomach
goes from cardiac sphincter—>
esophagus
Unlike the stomach, the esophagus is not
lined with acid-resistant mucus, so the acidic
mixture burns the walls of the esophagus and
causes pain
The reflux of acid usually takes place within
1-4 hours after a meal
It is important for patients with GERD to
avoid high-fat meals and
esophageal irritants (chocolate,
alcohol, peppermint, spearmint,
liqueurs, acidic foods)
Patients should also avoid overeating
Lifestyle changes is the primary way to
help manage GERD, followed by
medications, and lastly, surgery can be
required for severe chronic GERD Antacids [aluminum salts, Ca/Mg salts, sodium bicarbonate]
Histamine (H2) Blockers [-idine; ranitidine, nizatidine, cimetidine]
Proton Pump Inhibitors [-prazole; omeprazole, lansoprazole]
Esophageal Disorders
Esophagitis
Chronic reflux and GERD —> Esophagitis (inflammation of
the lower esophagus)
Worse with incr abdominal pressure from: coughing,
straining, bending, vomiting, heavy lifting, exercise; as well
as from obesity and pregnancy
Esophageal irritant foods and high-fat foods also increases
reflux
Esophagitis is treated the same way
GERD is treated
Hiatal Hernia
part of the stomach bulges upward through the diaphragm
Results in respiratory symptoms: pneumonia, chronic
bronchitis, asthma
Will exacerbate Gerd so
rx is similar to GERD (lifestyle A. Normal Stomach B. Hiatal Hernia
modifications, pharmacologic treatment,
surgery)
Stomach Disorders
Vomiting
Is reverse peristalsis
Involuntary muscular action that cannot be easily controlled
Often is painful as gastric juices burn the unprotected, unlined
esophagus
Can be a defense mechanism: pathogenic microorganism or
toxin (including excessive alcohol) enters the GI tract
Nausea often accompanies or precedes vomiting
motion sickness
Hormonal shifts (pregnant women)
Med side-effects (chemotherapies, immunosuppressants and
opioids)
Main concern: Dehydration and loss of fluid and
electrolytes —> encourage fluid intake
Small cold meals are better tolerated than hot meals when
nausea and vomiting (crackers and cheese, gelatin,
fruit, cold fruit juices)
Avoid hot, fried, and spicy foods
Stomach Disorders
Peptic Ulcer Disease (PUD)
break/ulcer (sore, in pouching) in the protective mucosal
lining of the lower esophagus, stomach (gastric ulcer) or
duodenum (duodenal ulcer)
Ulcer expose the submucosal areas to gastric secretions —
> ruin blood vessels, cause infections, and perforation of
the GI will (can become extremely painful)
Infections of Helicobacter pylori (H. pylori) =
duodenal ulcers
H. pylori weakens the protective mucosal layer of the
stomach and duodenum
Chronic use of NSAIDs, esp on empty stomach
NSAIDs promote mucosal inflammation by gastric
irritation, reduces mucus and bicarbonate (acid-
neutralizer) secretions
Treatment includes
Eradicating H. pylori with abx
Decr stomach acidity (reducing GERD methods, and
using similar medications)
GERD-reducing diet: no high-fat foods, avoid overeating,
avoid esophageal irritants
Stomach Disorders
Dumping Syndrome
large volume of digested foods is dumped too
rapidly into the intestines from the stomach
occur when pt has partial or total stomach removal
or stomach-bypass surgery (gastrectomy) – causes
a loss in the control of the rate of gastric emptying
into the small intestine
Symptoms: abdominal cramps, N/V, diarrhea,
weight loss
Vitamin B12 def is common bc pt loses part/all of
stomach
Treatment
Liquids between meals rather than with meals to
slow down the movement of food from the stomach
into the duodenum
Protein and fat are better tolerated than
carbohydrates in digestion
Intestinal Disorders
Diarrhea Celiac Disease (Gluten
oose, watery stool bc contents of the GI tract Sensitivity)
move through too quickly to reabsorbed
water in colon chronic autoimmune —> small intestine
mucosa damaged by dietary gluten
Persistent = dehydration and fluid
and electrolyte loss, imbalance – Treat Gluten as toxin = diarrhea, abdominal
give Parenteral (IV) or enteral therapy distention, weight loss, and fat
malabsorption (fat not absorbed and
Low-fiber intake is necessary excreted in feces; steatorrhea)
No Gluten (wheat, oats, rye, barley)
Constipation Nutritional supplements become important
difficulty passing stool, particularly hard, dry Lactose Intolerance
stools No lactase to digest lactose
Dehydration can cause constipation – Limiting lactose-containing foods, give ca,
increase water and fluid intakes to help bit D supplements
lubricate the intestines
Increase fiber intake and whole-grains
and exercise
Stool softeners and laxatives may be
prescribed
Intestinal Disorders
Irritable Bowel Syndrome (IBS)
A GI disorder with disturbed gut microbiota —> abdominal
discomfort, changes in bowel habits, and pain
Consists of alternating bowel habits, chronic constipation, or
chronic diarrhea as a result of other intestinal disorders
Considerations: infections, persistent diarrhea or
constipation, GI bleeding, anemia, and
abdominal masses
Weight loss can occur over time
IBD: Ulcerative Colitis or Crohn's
Disease
Crohn’s: all layers of the intestinal wall of the small and
large intestine —> thick intestinal walls, fistulas
Symptoms: diarrhea (with blood), abdominal pain, intestinal
bleeding, and nutritional and fluid-electrolyte depletion
Treatment: replace lost nutrients including nutritional
supplements, low-fiber, high-calorie and high-
protein diets
Intestinal Disorders
Diverticulitis
Weak musculature of the bowel walls,
diverticula forms (pouch-like herniations on
colon)
Caused by long-term constipation, straining,
and low-fiber diets
Diverticulitis = diverticula become inflamed
and infections can occur
Patients are given nothing by mouth, then
progress to liquids and other nutrition therapy
—> high-fiber diet becomes essential
ASSIGNMENT
1. What are diets that reduce inflammation and what food products do they contain?
2. Describe Dysphagia and the considerations regarding it
3. What are the lifestyle, pharmacological and dietary treatments for GERD?
4. What are health implications involved with vomiting?
5. What are causes and treatments for Peptic Ulcer Disease?
6. Describe Dumping Syndrome and treatments for it
7. Differentiate between Diarrhea and Constipation
8. Describe Crohn's Disease and Diverticulitis
