NUTRITION & GI DISORDERS

Prof.Dr.dr.Harun Alrasyid,SpPD,SpGK FK-USU Medan

SORROUNDING EVERY STOMACH IN A PERSON REFLECTING PHYSICAL & PSYCHOLOGICAL CONDITIONING

F o o d.
Accelerated action GI tract secretory function Neuromuscular function (motility) Absorbtive function sel p s y c h o g e n ..?

PROBLEM
ORAL : parotitis, stomatitis, retroph. abces,etc ESOFAGEAL:stenosis,achalasia, GERD, varices bleeding etc STOMACH: gastritis, stress ulcer,haematemesismelena, ulcers, etc SMALL INTESTINE :ulcers,GERD,etc LARGE INTESTINE:diverticulitis,constipation,IBS,colitis, etc

Dietary interventions in upper GI disorders

Cause of dysphagia physical,mechanical,nerological defects? Route oral, enteral, parenteral (partial/total) ? Food properties easy-to-manage textures & consistencies: -soft,cohesive foods (moist foods > dry foods) -more viscous beverages(milk shake) > thin liquids as water/ juice Food preparation Feeding strategies (head & neck posture while eating, speech & language therapists) Malnourished ? enteral nutrition

GERD/GORD.
A.Conditions that raise the likehood of reflux -Ascites -Delayed gastric emptying -Eating large meals -Obesity -Pregnancy -Wearing clothes that fit tightly across the waist or abdomen

GERD/GORD,cont.
B.Substance that weaken LES pressure - Alcohol,caffeine, chocolate, garlic, onions - High-fat foods, peppermint & spearmint oils - Anticholinergic agents, calcium channel blockers, diazepams, meperidine - Progesterone, theophylline

GERD/GORD,cont
Treatment: drug therapy,lifestyle modifications,others ad.Lifestyle: Avoid bedtime snacks or lying down after meals (meal consumed at least 2-3 hours before bedtime) Small meals and drink liquids between meals Limit foods that relaxing LES (alcohol,choc.,fatty foods) More proteins in foods than fats Avoid cigarettes,highly acidic & spicy foods Avoid using NSAID Avoid bending over & wearing tight-fitting garments To lose weight in obese Elevate the head of the bed on 6-inch blocks

DYSPEPSIA.
Causes by 1. Various medical condition 2. By dietary supplements: a.High- dose iron b.Some herbal remedies Potential food intolerance: Unable to find association between specific foods and dyspepsia by controlled studies

Dyspepsia,cont
Potential.. Coffee (including decaffeinated) symptoms in many people who complain of dyspepsia Spicy foods some injury to the mucosal lining (exacerbate the pain) High-fat meals slow gastric emptying, exacerbate dyspepsia

Dyspepsia,cont..
Dietary interventions for nausea Eating (small meals) & drinking slowly Dry, salty foods (crackers,pretzels) may reduce nausea Avoid fried or spicy foods and foods with strong odors Foods that are cold/room temperature may better tolerated than hot meals Individuals sometimes have strong food aversions when nauseated,and tolerances vary greatly

Gastritis
Dietary interventions: -Vary according to individiduals symptom -If any pain or discomfort, avoid irritating foods and beverage (alcohol, coffee, tea, cola, spicy foods, fatty and greasy foods)

Peptic ulcers disease..

Complications: -Signs of anemia (from bleeding) -Hypoproteinemia, BW Dietary considerations a.Only required if a persons symptoms are affect by food consumption b.Individualized to personal tolerance c.Avoid large meals and irritatting foods

Ad.Dietary considerations..
Goals: tissue integrity Digestibility,small portion and frequently (M1) Adequency of energy-protein, 10-15 % fats Acute phase PEN 1-2 days

Avoid..
Source of protein: whole milk (if intolerance),cheese CHO : cakes, cassava root (singkong), gelatinous rice (ketan) Fats : pure coconut oil, animal fat Drinks : tonic drink, soda, alcohol, coffee, ice cream Vegetables ~ gas (cauliflower, broccoli, legumes, cabbages) Hot spices

Post haematemesis melena

Medical Nutrition Therapy (MNT): Rest of upper GI tract, risk of rebleeding, prevents of aspiration, to maintenance of nutr. status PEN for acute phase, low residu, after (-) bleeding Sequence by liquid formula low residu

IRRITABLE BOWEL SYNDROME

The causes,remain elusive (stress & anxiety?) Hypersensitivity to intestinal distention? Treatment: stress management/behavioral along with dietary adjustments

IBS,cont.
MNT: Increase fiber intake (reduce constipation, improve stool bulk) To add fiber-containing foods gradually To avoid food producing gas unless well tolerated To add psyllium if diarrhea persists. Avoid milk products if lactose intolerance Generally, small and frequent meals, prevents air swallowed

INFLAMMATORY BOWEL DISEASE/IBD

OBJECTIVE OF MNT 1.To prevent progress of PEM (anaemia, nitrogen balance) 2.Approved physiologic function of GI tract 3.Approved fluid & electrolyte balance 4.To prevent nutrient deficit (Ca,Vit D)

MNT for IBS

1.Fluids (30 40 Cal/BW/d) 2.Energy (inflammation/absces/surgery?) 3.Macronutrients: -lactose intolerance? --_restricted -protein (1.0-1.5 gr/BW/d; oligomerik?) -fat, 20-40 gr/d (MCT) 4.Micronutr.: Vit B1,C,B12,Folate,ADEK; mineral Ca,Mg,Zn,Fe,Potassim

LIVER CIRRHOSIS..
MNT: Customized to each persons needs Avoiding the substances that may cause further liver injury - alcohols - drugs - herbal suppl, megadose vitamin & minerl

MNT,cont.
Nutrition Composition F l u i d restricted,due clinical states Energy: -Recommendation: 20-75% > BEE (30-35 Cal/BW/d, ~ complications ? ) -Malabsorption,weight loss,infection increase energy needs -Ascites ? based on desirable weight or estimated dry weight (without ascites) to avoid overestimating

MNT.
Protein - 1,2-1,5 gr/kg BW ~ clinical condition - high of vegetable protein (tempeh) - may add enteral formula /specific nutrients~ BCAA (30-40% total protein)

CHO -not advised CHO restricted -insulin resistance in cirrhosis if hyperglycaemia,give medication -small studies: high-fiber (dietary, low GI diets/ 45-50 % total CHO) may improve glucose tolerance in cirrhosis

MNT in cirrhosis.
Fat Restricted in steatorrhea Used MCT to provide additional energy Supplement of Essential FA (not present in MCT oils) Severe steatorrhea suppl. of fat soluble vitamins, calcium, magnesium and zinc

MNT
Sodium and fluid -restrict sodium (2-3 gr/d) + diuretic -monitoring Potasium if used furosemide Vitamines -recommended multivitamin supplementation (fat-soluble nutrients provides in water-soluble forms) in steatorhea

Minerals
Zinc sulphas 1-3 x 200 mg/d may benefit Se,Cr,Fe,Mg,Cu freq. deficiences

Modes of delivery
O r a l Enteral (small bore feeding tube) Parenteral

- Small and freq meals (late meal diets, 1 portion/15 % TER before retired)

Enteral and PEN support If cirrhotic patient unable to consume enough food By special enteral (tube feeding) formula: high calories, low sodium, high in BCAA If tube feeding failed (intestinal obstruction, GI bleeding, uncontrolled vomiting), use PEN If hyperglicaemia, give DS infusion limited about 5 mg/kg BW/minute Ascites concentrated nutrient formula (Central)

NUTRITION ASSESSMENT CHECKLIST for GI DISORDERS

MEDICAL HISTORY: medical diagnosis, surgical, symptoms MEDICATION (and herbal remedies) DIETARY INTAKE ANTHROPOMETRY DATA, LABORATORY TEST CLINICAL SIGN