Chapter 29

Medical Nutrition
Therapy for
Upper
Gastrointestinal
Tract Disorders
Disorders of the Esophagus
1. Gastroesophageal reflux disease
(GERD)
—Backward flow of the stomach and/or
duodenal contents into the esophagus
—Burning sensation after meals; heartburn
—Possible discomfort during and after eating,
change in eating habits, especially in the
evening

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Disorders of the Esophagus—cont’d
2. Hiatal hernia
—An outpouching of a portion of the stomach
into the chest through the esophageal hiatus
of the diaphragm
—Heartburn after heavy meals or with
reclining after meals
—May worsen GERD symptoms

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Disorders of the Esophagus—cont’d
3. Cancer of the oral cavity, pharynx, and
esophagus
—Existing nutritional problems and eating
difficulties caused by the tumor mass,
obstruction, oral infection and ulceration, or
alcoholism
—Chewing, swallowing, salivation, and taste
acuity are often affected.
—Weight loss is common.

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Common Symptoms of
Gastrointestinal Disease

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Nutritional Care Guidelines for Patients with
Reflux and Esophagitis

(Adapted from Bray GA. Gray DS, Obesity, part 1: Pathogenisis. West J Med 149:429, 1988; and Lew EA, Garfinkle L; Variations
in mortality by weight among 750,000 men and women. J Clin Epidemiol 32:563, 1979.)

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Disorders of the Stomach
1. Indigestion/dysphagia
—Epigastric discomfort following meals
—Abdominal pain, bloating, nausea,
regurgitation, and belching
—Eat slowly, chew thoroughly, and do not
eat or drink excessively.

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Disorders of the Stomach—cont’d
2. Gastritis
—Helicobacter pylori
—Infection and inflammation
—Acute gastritis: rapid onset of inflammation
and symptoms
—Chronic gastritis: occurs over period of
time
—Symptoms: nausea, vomiting, malaise,
anorexia, hemorrhage, and epigastric pain
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Disorders of the Stomach—cont’d
3. Peptic ulcer disease
—Primary causes: H. pylori infection,
gastritis, use of NSAIDs, corticosteroids,
and so-called stress ulcers
—Involves gastric and duodenal regions
—Gastric ulcers: in stomach; normal or low
acid secretion
—Duodenal ulcers: in duodenum; high acid
secretion
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Characteristics and Comparisons
Between Gastric and Duodenal Ulcers
■ Gastric ulcer formation involves inflammatory
involvement of acid-producing cells but usually
occurs with low acid secretion.
■ Duodenal ulcers are associated with high acid
and low bicarbonate secretion.
■ Increased mortality and hemorrhage are
associated with gastric ulcers.

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Peptic Ulcer–Cause

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000. Updated by Peter L. Beyer, 2002.

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Peptic Ulcer—Pathophysiology

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000.

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Peptic Ulcer—Medical and
Nutritional Management

Algorithm content developed by John Anderson, PhD, and Sanford C. Garner, PhD, 2000. Updated by Peter L. Beyer, 2002.

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Gastric and Duodenal Ulcers

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Factors That Affect Gastric Acidity

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Gastric Surgical Procedures

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Gastric Surgical Procedures—cont’d

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Dumping Syndrome
■ Complex physiologic response to the rapid
emptying of hypertonic contents into the
duodenum and jejunum
■ Dumping syndrome occurs as a result of total
or subtotal gastrectomy and is associated with
mild to severe symptoms including abdominal
distention, systemic systems (bloating,
flatulence, pain, diarrhea), and reactive
hypoglycemia.

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Nutritional Care Guidelines for Patients with
Dumping Syndrome and Alimentary Hypoglycemia

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Drugs Commonly Used to Treat
Gastrointestinal Disorders
■ Antacids: lower acidity
■ Cimetidine (Tagamet), ranitidine (Zantac):
block acid secretion by blocking histamine
H2 receptors
■ Prostaglandins
■ Sucralfate: coats and protects surface
■ Colloidal bismuth: coats and protects surface
■ Carbenoxolone: strengthens mucosal barrier
■ Tinidazole: antibiotic
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Dysphagia
■ Oral phase problems
Pocketing food
Drinking from cup or straw
Drooling
■ Pharyngeal phase
Gagging
Choking
Nasal regurgitation
■ Esophageal phase
Obstruction

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Diagnosis of Swallowing Difficulties
1. Barium swallow
2. Cookie swallow
— Record your observations during meals
— Treatment
— Adapt consistency of food: thickened
liquids puddings, custards, pureed;
chopped or diced foods

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Diseases of Stomach
■ Indigestion
■ Acute gastritis from: H. pylori tobacco,
chronic use of drugs such as:
—Alcohol
—Aspirin
—Nonsteroidal antiinflammatory agents

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Diseases of Stomach—cont’d

■ Chronic gastritis
Precedes gastric lesion like cancer or
ulcer
H. pylori infection may cause
Sx—Indigestion, loss of appetite, feeling
full, belching, epigastric pain, nausea,
vomiting

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Diseases of Stomach—cont’d
Rx: Avoid foods not tolerated; soft consistency;
regular meals; chew foods
—Avoid highly seasoned foods; avoid excess
liquid at meals
■ Atrophic gastritis:
—Stomach cells atrophy
—Loss of parietal cells—achlorhydria
—Lose IF for B12 absorption

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Peptic Ulcer Disease
Treatment with Diet
■ Reduce decaffeinated and regular coffee,
cocoa, and tea intake
■ No alcohol or pepper
■ Avoid low-pH juices if they cause problems
■ Avoid irritating foods
■ Avoid food right before bedtime
■ Eat at least 3 small meals per day, 6 better

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Disorders of the Stomach—
Nutritional Care
■ Lifestyle changes are an important
component of the nutrition care plan.
■ Patients with dyspepsia should avoid
high-fat foods, sugar, caffeine, spices,
and alcohol.

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Diabetic Gastroparesis
(Gastroparesis Diabeticorum)
■ Delayed stomach emptying of solids
■ Etiology—autonomic neuropathy
■ Nausea, vomiting, bloating, pain
■ Insulin action and absorption of food not
synchronized
■ Prescribe small frequent meals (may need
liquid diet)
■ Adjust insulin
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Summary
■ Upper GI disorders—H. pylori plays an
important role
■ Maintain individual tolerances as much
as possible.

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