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

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

3. 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?

4. 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

5. 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

6. 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

7. 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!

8. 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

9. 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

10. 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

11. Vitamin D - grey skies in August…

12. 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

13. 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

14. Malabsorption, what is it?

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

16. 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

17. 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…

18. 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

19. Thank you for listening Any questions?