A Practical Application for Students With GI Upset GI Issues A Practical Application for Students With GI Upset Andrea Kendrick, RD, LDN www.AndreaRD.com Tennessee Academy of Nutrition and Dietetics Reimbursement Rep Knoxville Academy of Nutrition and Dietetics Media Spokesperson & Social Media Chair

Scenario 16 year old Female, HL Comes to your office with abdominal pain and “needing to go to the bathroom” This is the 2nd time this week. She has been in 3 times last week. Coffee and protein bar for breakfast No medical hx of GI disorders reported This visit she shares she recently broke up with her boy friend You currently do not think much of it

Issues of the GI Tract

Causes of Diarrhea Virus Bacteria Intolerance EX: foodborne illness Intolerance EX: gluten or lactose Inflammatory Bowel Disease Ulcerative colitis Crohn’s Celiac disease What about IBS?

Inflammatory Bowel Disease Ulcerative Colitis Continuous inflammation of the colon (type of IBD) Crohn’s Disease Healthy intestine mixed in between inflamed areas (type of IBD) Mostly occurs in the small intestine Inflammation can occur anywhere from mouth to anus Both can occur at any time Usually bw ages 15 – 30 years Cause is unclear but may involve: genetics, environment, and an overactive immune system

Celiac Disease Autoimmune disorder affecting 1 in 100 people worldwide 2.5 million Americans are undiagnosed and at risk for long term health complications Celiac disease is hereditary Long term health effects: iron deficiency anemia, early onset of osteoporosis/osteopenia, infertility/miscarriage, lactose intolerance, vitamin & mineral deficiencies, pancreatic insufficiency, intestinal lymphomas, gall bladder malfunction, neurological manifestations like seizures, migraine, neuropathy

Irritable Bowel Syndrome (IBS) Chronic disorder affecting between 5% –20% of kids and ~ 20% of adults 14% high school students 6% middle school students complain of IBS-like symptoms. Girls and boys are equally affected No known gene that causes IBS, but seems to occur in families Not a progressed disease – symptoms can be managed Symptoms are present but usual not evidence of tissue damage

Symptoms Include Bloating- IBS, CD, UC, Cr Cramping – IBS, UC, Cr Chronic or intermittent diarrhea – IBS, CD, UC, Cr Chronic or intermittent constipation – IBS, CD Urgency with defecation Incomplete sensation of defecation Passage of mucus in the stool CD also associated with vomiting, pale, foul-smelling or fatty stool, weight loss, fatigue, irritability or behavioral issues, dental enamel defects of permanent teeth, delayed growth and puberty, short stature, failure to thrive, ADHD UC – blood or pus in the stool, fever, weight loss, fatigue, reduced appetite, anemia if moderate to severe Crohn’s – rectal bleeding, unexplained weight loss, fever, fatigue, reduced appetite

Children with IBS May Experience: Problems with how food moves through the digestive system Hypersensitivity of the inside of the bowel to stretching and motion Stress Overgrowth of bacteria in the bowel

HL is back in your office again for the third week in a row Visiting 3 – 4 days per week You decide to press in a little more and ask if she has been to the doctor She has not she figured it was just stress but you encourage her to go to her doctor Next week she shares she has been to her doctor and a gastroenterologist and has a series of tests scheduled to determine what the source of her GI issues

Diagnosis of IBS – Process of Elimination Blood test – check for anemia or infection Urine analysis & culture Stool sample – rule out bacteria and parasites Stool sample for occult – to test for inflammatory source in the GI tract Lactose breath H test – rule out lactose intolerance Abdominal X-ray, US, Endoscopy, Colonoscopy – imaging and biopsy to rule out

HL is diagnosed with IBS she is working with her GI doctor and a registered dietitian

Treatment No cure for IBS, but can be treated with a combination therapy: Changes in eating, diet, and nutrition Medications Fiber supplements, laxatives, antidiarrheals, antispasmodics, antidepressants Probiotics Therapies for mental health problem

Nutrition Plan Large meals can cause cramping and diarrhea Smaller meals more often may help IBS symptom Low fat and high carbohydrate diets help Certain foods & drinks may cause IBS symptoms such as: foods high in fat milk products drinks with caffeine drinks with large amounts of artificial sweeteners or sugar alcohols foods that may cause gas, such as beans and cabbage

Low FODMAP Diet Fermentable Oglio- Di- Mono-saccharides And Polyols Quite restrictive Not appropriate for all cases but it is quite effective Fructans (a type of fiber found in wheat, onions, garlic and chicory root Oligosaccharides (a type of fiber found in beans, hummus and soy milk) Lactose (also known as milk sugar; found in milk, yogurt and ice cream) Fructose (also known as fruit sugar; found in fruit, high-fructose corn syrup, honey and agave syrup) Sorbitol, mannitol, and other “-ol” sweeteners (also known as sugar alcohols; found in certain fruits and vegetables as well as some types of sugar-free gums and candies)

School Nurse Checklist Let the teachers know Frequent bathroom visits Maybe create a sign with teacher to indicate need to use the restroom Talk to school counselor Discuss any stressors School Nurse Possibly allow student to use the private restroom Map out bathrooms Encourage student to know where the closed restroom is located for each class Possible 504 plan

Resources

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