Dietary Management for: Gastritis Peptic Ulcer Disease Gastric Surgery

Geofrey P. Maglalang

Gastritis
Endoscopy reveals severe gastritis with gastrointestinal bleeding.

Gastritis Acute or chronic inflammation of the mucous membrane of the stomach resulting in tissue damage and erosion, which expose the underlying cells to gastric secretions and pathogens.

Generally manifested by: Anorexia Nausea Vomiting Malaise Belching (gas) feeling of fullness Epigastric pain Occasionally, fever and diarrhea is presented

Causes: Bacterial or viral infection, excess stomach acid, use of NSAIDs, and stress are among the causative factors are gastritis. Helicobacter pylori infection has been specifically identified as primary contributory.

Dietary Management In acute gastritis, it may be necessary to withhold food for 24 hours to allow stomach to rest. Initiate oral diet the following day beginning with clear liquids, then full liquids to soft diet as per individual tolerance. They require folate and vitamin B12 supplementation

The following must be discussed during patient education:

Milk or cream as treatment component of gastritis and ulcer is no longer considered beneficial. Milk as a protein food has temporary neutralizing effect on gastric acid, but also stimulate secretion of gastrin and pepsin. Alcohol may cause superficial mucosal damage and therefore should be avoided by the patient with gastritis. The pH of food prior to ingestion is not likely to cause tissue damage or interfere with healing

 Coffee, red and black pepper, and large intake of chilli pepper must be avoided. These are strong irritants of mucosal cells. It is better to consume three meals per day to prevent an increase in acid production.

Peptic Ulcer Disease

Duodenal Ulcer

Peptic Ulcer Disease A peptic ulcer is a chronic sore or crater extending through the protective mucous membrane lining and penetrating the underlying muscular tissue of the gut. An ulcer can form in any area exposed to gastric acid and pepsin, a digestive enzyme instrumental in the break down of protein and hence the name peptic ulcer

pylorus

Gastric ulcer

duodenum

Duodenal ulcer

Causes: H. pylori responsible for the majority of ulcer - Weakens protective mucous coating of

stomach and duodenum, which allows acid to get through the sensitive lining beneath. Long term use of NSAIDs

Other factors: Smoking cause duodenal ulcer and has been shown to delay ulcer healing Poor nutrition poor supply of needed nutrients for defense and repair Stress it may worsen the pain or indigestion associated with ulcer Alcohol abuse causes irritation of lining of the stomach but has not been proven to cause duodenal ulceration Heredity increased threefold

Signs of uncomplicated PUD

Heartburn Nausea Abdominal distention Flatulence

Regurgitation

Outstanding Sudden weakness symptoms

Melena

Pharmacologic Treatment Use of antibiotics, antacids, H2 blocker, or cytoprotective agents

Dietary Management: No food is allowed while an ulcer is bleeding; instead the patient may be given IV feedings of dextrose and amino acids As the condition improves, patient progresses from full liquid diet to regular diet with omission of irritants based on individual tolerance Highly spiced dishes, fatty foods, or fruit juices can provoke ulcer symptoms but may be consumed freely if they do not

Gastric Surgery

Gastric surgery / gastrectomy Usually advised when ulcer is complicated by perforation, obstruction, and hemorrhage. Damage following trauma, such as gunshot wound, or auto accidents may also need surgical measures.

Two problems that likely to occur after surgey: Fat malabsorption results from bypass of duodenum. Bacteria multiply within the bypass, and bacteria deconjugate bile salts making micelle formation and fat absorption inadequate Dumping Syndrome dizziness and tachycardia occurs because food no longer empties at a control rate into the intestine. Instead, food rapidly dumped into jejunum.

Intestinal contents become hypertonic

Water from the lumen of intestinal capillaries moves into the lumen of jejunum to equalize load

Volume of circulating blood is reduces

Blood pressure falls down

After 2 3 hours, dizziness, fainting nausea, and sweating recur from hypoglycemia

Carbs from meal rapidly hydrolyzed and absorbed

Pancreas will respond by overproducing insulin

hyperglycemia

Dietary Management Post-surgery for patients with symptoms of Dumping Syndrome Foods containing proteins and fat Small frequent dry meals should be taken The patient should wait 45 min after eating before drinking liquid and suggest to lie down after meals

Other nutrition concerns: Iron Deficiency Anemia blood loss from surgery, accompanied by poor nutrition and poor iron absorption. Iron supplements help correct deficiency Calcium may be poorly absorbed post-op. supplements may be prescribed. Anemia caused by Vit. B12 deficiency. It is injected monthly to correct deficiency

After gastrectomy: Limit sources of simple sugars (glucose, fructose, sucrose) lessen hypersomolar load Small frequent dry meals are encouraged; fluids should be taken between meals (30 45 min after meal) Avoid excess fat intake (30% of total kCal or less) Use less milk and milk products because lactose intolerance is common. Emphasize other sources of calcium and Vitamin D

 Avoid extremes in temperature Diet should provide sufficient fiber, Vitamin B12 and B2, iron, folacin, and chromium. These nutrients may be given in supplemental forms as appropriate.