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NUTRITION & GI

DISORDERSProf.Dr.dr.Harun Alrasyid,SpPD,SpGK

FK-USUMedan

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SORROUNDING EVERY STOMACH

IN A PERSONREFLECTING PHYSICAL &

PSYCHOLOGICAL CONDITIONING

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F o o d.

Accelerated action GI tract

secretory function

Neuromuscular function (motility)

Absorbtive functionsel

p s y c h o g e n ..?

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PROBLEM

ORAL : parotitis, stomatitis, retroph. abces,etc

ESOFAGEAL:stenosis,achalasia, GERD, varices

bleeding etc

STOMACH: gastritis, stress ulcer,haematemesis-

melena, ulcers, etc

SMALL INTESTINE :ulcers,GERD,etc

LARGE INTESTINE:diverticulitis,constipation,IBS,colitis,

etc

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Dietary interventions in upper GI disorders

Cause of dysphagiaphysical,mechanical,nerological

defects?

Routeoral, enteral, parenteral (partial/total) ?

Food properties

easy-to-manage textures & consistencies:-soft,cohesive foods (moist foods > dry foods)

-more viscous beverages(milk shake) > thin liquids as

water/ juice

Food preparationFeeding strategies (head & neck posture while eating,speech & language therapists)

Malnourished ?enteral nutrition

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GERD/GORD.

A.Conditions that raise the likehood of reflux

-Ascites

-Delayed gastric emptying

-Eating large meals-Obesity

-Pregnancy

-Wearing clothes that fit tightly across the waist or

abdomen

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GERD/GORD,cont

Treatment: drug therapy,lifestyle modifications,others

ad.Lifestyle:

Avoid bedtime snacks or lying down after meals

(meal consumed at least 2-3 hours before bedtime)Small meals and drink liquids between meals

Limit foods that relaxing LES (alcohol,choc.,fatty foods)

More proteins in foods than fats

Avoid cigarettes,highly acidic & spicy foods

Avoid using NSAID

Avoid bending over & wearing tight-fitting garments

To lose weight in obese

Elevate the head of the bed on 6-inch blocks

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DYSPEPSIA.

Causes by

1. Various medical condition

2. By dietary supplements:

a.High- dose ironb.Some herbal remedies

Potential food intolerance:

Unable to find association between specific foods and

dyspepsia by controlled studies

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Dyspepsia,cont

Potential..

Coffee (including decaffeinated)

symptoms in many people who complain of

dyspepsia

Spicy foodssome injury to the mucosal lining

(exacerbate the pain)

High-fat mealsslow gastric emptying,

exacerbate dyspepsia

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Peptic ulcers disease..

Complications:

-Signs of anemia (from bleeding)

-Hypoproteinemia, BW

Dietary considerations

a.Only required if a persons symptoms are

affect by food consumption

b.Individualized to personal tolerance

c.Avoid large meals and irritatting foods

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Ad.Dietary considerations..Goals: tissue integrity

Digestibility,small portion and frequently

(M1)Adequency of energy-protein, 10-15 %

fats

Acute phasePEN 1-2 days

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Avoid..

Source of protein: whole milk (if intolerance),cheese

CHO : cakes, cassava root (singkong),

gelatinous rice (ketan)

Fats : pure coconut oil, animal fat

Drinks : tonic drink, soda, alcohol, coffee,

ice cream

Vegetables ~ gas (cauliflower, broccoli, legumes,

cabbages)

Hot spices

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Post haematemesis melena

Medical Nutrition Therapy (MNT):

Rest of upper GI tract, risk of

rebleeding, prevents of aspiration, to

maintenance of nutr. status

PEN for acute phase, low residu, after (-)

bleeding

Sequence by liquid formula low residu

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IRRITABLE BOWEL SYNDROME

The causes,remain elusive (stress &

anxiety?)

Hypersensitivity to intestinal distention?

Treatment: stress management/behavioralalong with dietary adjustments

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IBS,cont.

MNT:

Increase fiber intake (reduce constipation,improve stool bulk)

To add fiber-containing foods graduallyTo avoid food producing gas unless welltolerated

To add psyllium if diarrhea persists.

Avoid milk products if lactose intolerance

Generally, small and frequent meals, preventsair swallowed

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INFLAMMATORY BOWEL DISEASE/IBD

OBJECTIVE OF MNT

1.To prevent progress of PEM (anaemia,

nitrogen balance)2.Approved physiologic function of GI tract

3.Approved fluid & electrolyte balance

4.To prevent nutrient deficit (Ca,Vit D)

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MNT for IBS

1.Fluids (3040 Cal/BW/d)

2.Energy (inflammation/absces/surgery?)

3.Macronutrients:-lactose intolerance? --_restricted

-protein (1.0-1.5 gr/BW/d; oligomerik?)

-fat, 20-40 gr/d (MCT)4.Micronutr.: Vit B1,C,B12,Folate,ADEK;

mineral Ca,Mg,Zn,Fe,Potassim

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LIVER CIRRHOSIS..

MNT:

Customized to eachpersons needs

Avoiding the substances that may causefurther liver injury

- alcohols

- drugs- herbal suppl, megadose vitamin & minerl

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MNT,cont.

Nutrition Composition

F l u i d restricted,due clinical states

Energy:

-Recommendation: 20-75% > BEE

(30-35 Cal/BW/d, ~ complications ? )

-Malabsorption,weight loss,infection

increase energy needs

-Ascites ?based on desirable weight orestimated dry weight (without ascites) to

avoid overestimating

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CHO

-not advised CHO restricted

-insulin resistance in cirrhosisif hyperglycaemia,give medication

-small studies: high-fiber (dietary, low GI diets/

45-50 % total CHO) may improve glucosetolerance in cirrhosis

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MNT in cirrhosis.

Fat

- Restricted in steatorrhea

- Used MCT to provide additional energy- Supplement of Essential FA (not present

in MCT oils)

- Severe steatorrheasuppl. of fat solublevitamins, calcium, magnesium and zinc

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MNT

Sodium and fluid

-restrict sodium (2-3 gr/d) + diuretic

-monitoring Potasium if used furosemide

Vitamines

-recommended multivitamin supplementa-

tion (fat-soluble nutrients provides inwater-soluble forms) in steatorhea

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Minerals

Zinc sulphas 1-3 x 200 mg/d may benefit

Se,Cr,Fe,Mg,Cufreq. deficiences

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Modes of delivery

O r a lEnteral (smallbore feeding

tube)Parenteral

- Small and freq meals

(late meal diets, 1 portion/15 % TER

before retired)

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Enteral and PEN support

- If cirrhotic patient unable to consume enoughfood

- By special enteral (tube feeding) formula:high calories, low sodium, high in BCAA

- If tube feeding failed (intestinal obstruction, GIbleeding, uncontrolled vomiting), use PEN

- If hyperglicaemia, give DS infusion limited about5 mg/kg BW/minute

- Ascitesconcentrated nutrient formula (Central)

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NUTRITION ASSESSMENT

CHECKLIST for GI DISORDERS

MEDICAL HISTORY:

medical diagnosis, surgical, symptoms

MEDICATION (and herbal remedies)DIETARY INTAKE

ANTHROPOMETRY DATA,

LABORATORY TESTCLINICAL SIGN

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