1. © 2007 Thomson - Wadsworth Chapter 17 Nutrition & Upper Gastrointestinal Disorders

2. © 2007 Thomson - Wadsworth Dry Mouth: Xerostomia Reduced salivary flow Side-effect of medications Poorly controlled diabetes Sjogren’s syndrome Radiation therapy Mouth breathing Consequences Increased plaque Tooth & gum disease Mouth infections Interference with speech Bad breath Difficulty chewing & swallowing Diminished taste Ulcers from dentures Reduced food intake

3. © 2007 Thomson - Wadsworth

4. Dysphagia: Difficulty Swallowing Oropharyngeal dysphagia Transfer of food from mouth to esophagus Problem of tongue, other oral tissues or swallowing reflex Symptoms Inability to initiate swallowing Coughing during or after swallowing Nasal regurgitation Bad breath “Wet” voice Stroke is a frequent cause

5. © 2007 Thomson - Wadsworth Dysphagia: Difficulty Swallowing Esophageal dysphagia Transfer of food through esophagus to stomach Complaints of “food sticking” after swallowing Causes Obstruction in esophagus Motility disorder Aspiration: a potential complication of oropharyngeal or esophageal dysphagia

6. © 2007 Thomson - Wadsworth

7. National Dysphagia Diet Level 1: Dysphagia pureed Moderate to severe dysphagia Poor oral or chewing ability Level 2: Dysphagia mechanically altered Mild to moderate dysphagia Level 3: Dysphagia advanced Mild dysphagia Level 4: Liquid consistencies Thin Nectarlike Honeylike Spoon-thick

8. © 2007 Thomson - Wadsworth Food Properties & Preparation Offer Easy to manage textures & consistencies Soft, cohesive foods Moist rather than dry One texture at a time Thickeners Pureed, mashed, ground, or minced Avoid Sticky or gummy foods Nuts & seeds More than one texture Thin liquids Use a variety of colors & shapes

9. © 2007 Thomson - Wadsworth Gastroesophageal Reflux Disease GERD Reflux of acidic stomach contents into the esophagus Heartburn or acid indigestion Causes discomfort & may cause tissue damage Conditions associated with GERD Pregnancy Asthma Hiatal hernia Obesity Large meals Some medications Nasogastric tubes Treatment Proton-pump inhibitors Histamine-2-receptor blocking agents

10. © 2007 Thomson - Wadsworth

11. Conditions Affecting the Stomach Dyspepsia Nausea & Vomiting Gastritis Peptic Ulcer

12. © 2007 Thomson - Wadsworth Dyspepsia General discomfort in the upper abdominal area Teaching Small meals with well-cooked foods Lightly seasoned Relaxed atmosphere Causes Peptic ulcers GERD Motility disorders Malabsorption disorders Gallbladder disease Tumors in abdominal region Some medications & dietary supplements

13. © 2007 Thomson - Wadsworth Nausea & Vomiting Accompanies many illnesses Common side effect of many medications Correct underlying disorder May need to restore hydration Dietary interventions Eating & drinking slowly Small meals Clear, cold beverages Dry salty foods Foods cold or at room temperature

14. © 2007 Thomson - Wadsworth Gastritis Inflammation of the stomach mucosa Causes Helicobacter pylori infection Irritating substances Damage to stomach lining (diseases/ treatments) Acute erosive gastritis or chronic atrophic gastritis Complications Low or absent hydrochloric acid Impaired absorption of nonheme iron & vitamin B 12 Dietary interventions Avoid alcohol, coffee, tea, cola, spicy foods, & fatty, greasy foods

15. © 2007 Thomson - Wadsworth Peptic Ulcer Gastric & duodenal Causes Effects of hydrochloric acid & pepsin Helicobacter pylori infection Non-steroidal anti- inflammatory drugs Other risk factors Cigarette smoking Emotional stress Genetic factors

16. © 2007 Thomson - Wadsworth Peptic Ulcers Signs & symptoms Hunger pain Sensation of gnawing Burning in stomach Complication GI bleeding Weak & fatigued Black, tarry stools Coffee ground vomit Drug therapy Antibiotics Discontinue aspirin & NSAIDS Antisecretory agents Bismuth preparations or sucralfate Avoid irritating foods Avoid large meals

17. © 2007 Thomson - Wadsworth Gastric Surgery Treatment for Severe obesity Peptic ulcer Stomach cancer

18. © 2007 Thomson - Wadsworth Gastrectomy Removal of diseased portions of the stomach Other Vagotomy: suppresses acid secretion Pyloroplasty: widens pyloric sphincter from stomach to the duodenum Postgastrectomy diet Several small meals & snacks Progress to 5-6 small meals/day Avoid sweets & sugars Fiber to delay stomach emptying Avoid irritating foods May need to avoid milk products (lactose intolerance) Liquids between meals

19. © 2007 Thomson - Wadsworth Typical Gastric Surgery Resections

20. © 2007 Thomson - Wadsworth

21. Post-Surgical Problems Dumping Syndrome Abnormally rapid gastric emptying Goals Limit amount of food reaching the intestine Slow rate of gastric emptying Reduce foods that increase hypertonicity Fat malabsorption Deficiencies of fat- soluble vitamins & some minerals Bone disease Malabsorption of calcium & vitamin D Anemia Impaired iron & vitamin B 12 absorption due to decreased hydrochloric acid

22. © 2007 Thomson - Wadsworth

23. Bariatric Surgery Creates a gastric pouch which restricts meal size to about a cup Bypasses part of small intestine, decreasing absorption Lose between 49-62% of excess weight After weight loss, may need plastic surgery to remove excess skin Progressive diet Fluids consumed separately Education on food portions To avoid dumping syndrome To maintain weight loss Need dietary supplements

24. © 2007 Thomson - Wadsworth