OOSO MEETING: Nutritional Difficulties after UGI Surgery Liz Ward Specialist Dietitian, UGI Churchill Hospital, Oxford 03.12.12

Suggested topics to cover: Malabsorption Vitamin Deficiencies Managing eating and good foods to cook after UGI surgery Improving the Dietetic Service for UGI patients

Aims: Improving the Dietetic Service for UGI in Oxford Vitamin Deficiency Risk post UGI Surgery and local work to investigate and manage Malabsorption after UGI surgery – what are the symptoms, the implications and how to manage it?

Improving the Dietetic Service Oxford UGI unit has increased in size with more patients More treatments, longer treatments with a bigger demand on patients nutritional reserve Implications on managing and coping with treatment Also – big implications for managing and coping with life after surgery Macmillan.org.uk

Improving the Dietetic Service Meet ALL new patients at initial clinic appointments Dietetic attendance at the Oncology clinic Provide pre surgery education for patient/family Increased support post surgery – new clinics Ongoing and long-term support for patients to help with problems that limit and affect QOL

Benefits of the improved Dietetic Service Reduce anxiety on admission for patient and family Provide more confidence for starting to eat and feel in control Feel more prepared for discharge Allow you to recover to the maximum following surgery Help you to live a normal life/as normal as possible

Your views: Patient questionnaire to capture your views and suggestions Please fill in today and leave at the end of the session or Take home and complete and return with the SAE PLEASE ADD AS MUCH DETAIL AS POSSIBLE Thankyou!

Risk of Nutritional Deficiency Is their a risk of nutritional deficiencies following UGI surgery? Total Gastrectomy – receive vitamin B12 injections Subtotal Gastrectomy or Oesophagectomy – no formal advice Investigated: What other centres are doing Research project collecting blood results Presented the results to a regional meeting recently

Oxford Results ALL types of surgery (oesophagectomy, total gastrectomy or subtotal gastrectomy): Low vitamin D levels Low iron levels Low vitamin B12 levels Similar results to other centres

Why Nutritional Deficiencies? Dietary: Poor food intake Poor appetite Difficulty with food textures Effect of surgery: Less acid production Less stimulation of pancreatic juices Less churning and breakdown of food Rapid gut timing Less stomach factors Effects of Treatment: Chemotherapy or Radiotherapy Medications: Long-term use of antacids Gut Effects: Diarrhoea Malabsorption Gut bacteria Dumping Pre-existing Deficiencies: Low vitamin D levels common in the UK Increasing age

Vitamin D - grey skies in August…

Symptoms and Effects of deficiencies: Iron: Impact: tiredness, weakness, short of breath Found in :meat, fish, poultry, green leafy veg Vitamin B12: Impact: weakness, tiredness, light headedness, tingling, muscle weakness Found in: animal products such as meat, shellfish, dairy products and eggs Vitamin D: Impact: Bone health, depression, mood, dementia Found in: sunlight, oily fish such as salmon, mackerel, sardines, fortified cereal and eggs

What can you do to help? Try to eat a good variety of foods (discuss if the time is right with your Dietitian) Take a daily Multivitamin and Mineral Supplement (A-Z or Complete) Ask for a blood test at your next appointment in clinic Ask to see a Dietitian at your next appointment If you suspect symptoms, speak with your GP and ask for a blood test

Malabsorption, what is it?

How common is malabsorption? This study suggests that following an oesophagectomy or gastrectomy 73% of patients may have malabsorption symptoms

How do I know if I have Malabsorption? Common symptoms: Abdominal discomfort following eating Loose stools with/without urgency Pale stools that float, difficult to flush, offensive smelling Excessive wind, bloating Weight loss Preventing malabsorption: Listen to your body and if you feel unwell after eating: Slow down Cut down Make changes Sometimes not avoidable so speak with your Dietitian

Managing Malabsorption Eating more slowly will help to slow the rapid movement of food through the gut and aid digestion Eating smaller amounts will help in the same way Protein rich foods can help to slow down movement through the stomach (and also important for weight and muscle strength) Never compare pre surgery portion sizes to what you are eating now Even if you feel that you are getting away with larger portions, you probably are not…

Managing Malabsorption If you have reduced digestive juice production it can help to take a tablet Creon™ is a replacement for pancreatic juices which aid breakdown and digestion of foods We can consider overgrowth of bacteria in your gut if Creon is not beneficial (depending on symptoms) Keep a food and symptom diary This can be invaluable in helping to identify the problem and possible cause Discuss with your Dietitian

Thank you for listening Any questions?