1. UPPER GASTROINTESTINAL DISEASE

2. Nutrition and Gastrointestinal Disorders Nutrition and intestinal function are intimately interrelated. The chief purpose of the gut is to digest and absorb nutrients in order to maintain life. Consequently, chronic gastrointestinal (GI) disease commonly results in malnutrition and increased morbidity and mortality.

3. Causes of Upper Gastrointestinal Diseases H. Pylori infection Stress gastritis Aspirin and other NSAIDs Repeated vomiting Anorexia Bulimia Obesity pregnancysmoking

4. Management Medical Management Reduce or withdraw use of NSAIDs. Use antibiotics, sucralfate, antacids. Behavioral Management Small, frequent meals of well-balanced diet. Stop eating 2 to 3 hours before bedtime. Stay upright for 3 hours after meals. sleep on a slight angle. Quit smoking. Omitting rapid eating, chewing gum to reduce bloating and stomach gas. Wear loose-fitting clothing around your abdomen. Nutrition Management Decrease consumption of greasy and spicy foods and alcoholic drinks. Avoid carbonated beverages, citrus fruits and juices. Decrease consumption of caffeine. Increase intake of n-3 and n-6 fatty acids. Good chewing of food. Stop overeating. losing weight if you’re overweight or obese. Sucralfate a drug used in the treatment of gastric and duodenal ulcers. It is a complex of aluminium hydroxide and a sulphate derivative of sucrose.

5. Recommendation Protein: Receive no less than 0.8 gram of low-fat protein per kilogram of body weight. If there has been blood loss, protein may be increased to 1 or 1.5 grams per kilogram of body weight. Fat: Fat-free or low-fat diet. Carbohydrates have little effect on gastric acid secretion. Vitamin and mineral: iron if there has been hemorrhage, may be prescribed. People who avoid citrus juices because of their acidity should be encouraged to eat other sources of vitamin C.

6. Dietary recommendations for Upper Gastrointestinal Diseases Food Classification Suggested Daily Servings Recommended choicesLimit or Avoid Milk And milk products 2-3 Milk (fresh, dried or evaporated), cream, yogurt, cheese and cottage cheese. Limit high fat dairy Meats and protein alternatives 2 servings (2-3 oz portions) Fresh or frozen meat, poultry and fish, canned meats (tuna and salmon), eggs, nuts, seeds, dry beans or peas. Most meat & poultry choices should be lean or very lean. Limit high fat, fried meats, or large amounts of gravies. Vegetables 1-4 cups (4-6 servings) Fresh, canned or frozen vegetables served in any form. 100% vegetable juices. Limit fried, augratin or cream sauces on veg.

7. Food Classification Suggested Daily Servings Recommended choicesLimit or Avoid Fruits1-2 ½ cups (2-5 servings) Fresh, frozen or canned fruits and 100% juices of all kinds. Limit Avocados Grains and grain products3-10 Use whole-grain or enriched breads, pasta, oatmeal, breakfast cereals, tortillas, grits, white, brown or wild rice, popcorn, cornbread, crackers, pretzels, buns, rolls, English muffins. It is recommended to use at least 3 servings of whole-grain cereals daily. Go easy on high fat breads, muffins, biscuits, etc. Nuts, seeds, and beans4-5 a week All varieties of nuts, seeds and beans. Dietary recommendations for Upper Gastrointestinal Diseases

8. Food Classification Suggested Daily Servings Recommended choicesLimit or Avoid Fats and Oils Use sparingly not generously 2-3 times a day Margarine, butter, mayonnaise, butter, salad dressing, gravies, cream sauces, sour cream. Make most of your fats sources from fish, nuts & vegetable oils (Olive & canola esp.) Limit portions. Sweets1 or <1 per day All sweets and desserts in limited portions and amounts. Limit high fat choices. Fluids6-8 cups Water and other fluids, such as fruit juice, vegetable juice, lemonade, or soups Water and other fluids, such as fruit juice, vegetable juice, lemonade, or soups. Seasonings/ Condiments/ Sauces As desired Encourage limited quantities of all that are high in salt for normal healthy diet. Limit black pepper, garlic, cloves, and chili powder Dietary recommendations for Upper Gastrointestinal Diseases

9. Case study Noor is a 20-years-old female; 166 cm height and 49 kg weight. She lost her weight lately, as she does not have the desire to eat. Since a year and half, she has been drinking about 2-3 cups of black coffee daily and her eating is not very well as she was anxious about her grades and accepting her as a freshman at KAU. Recently, she has been felt a burn and noisy pain in her stomach, which after seeing a doctor, it appeared to be at risk of advanced stage of ulcer.

10. Case study Answer the following: 1_ Identify this patient’s risk factors for ulcer disease. 2_ Make the assessments you need to plan appropriate meals for Noor. 3_ What education and advices would you gave it to Noor?