Diet and GI Disease Flashcards
What is eosinophilic esophagitis?
chronic allergic inflammatory condition with eosinophilic infiltration of the lining of the esophagus
What are characteristics of eosinophilic esophagitis?
long-term damage including scarring and strictures
odynophagia or dysphagia (may result in food impaction, inability to eat, reflux)
Reflux can cause further irritation
How is eosinophilic esophagitis treated?
medication
diet changes
What dietary modifications can be made to treat eosinophilic esophagitis?
Removing allergy causing foods
SFED
Elemental diet
What are the key characteristics of the six-food elimination diet?
diet based on removing six most common allergy-causing foods: milk, wheat, eggs, soy, peanuts/tree nuts, fish/shellfish
what are benefits of the SFED?
improves disease process in a majority of patients (histologic response in 69% of patients, symptom response in 87% of patients)
no other restrictions other than allergy foods in terms of diet unless specified by provider
What is a elemental diet?
Diet based on nutrient-enriched amino acid formulas
amino acids mixed with sugars, fats, minerals, and vitamins totally replace table food
usually for a short period
what population is elemental diet used more often in?
children (but can be used in adults)
what is the benefit of the elemental diet?
improves disease in majority of patients (95% histologic, 100% symptom)
disease characterized by recurrent retrograde acid reflux in the esophagus
gastroesophageal reflux disease
what are symptoms of GERD?
burning pain, often shortly after eating, difficulty swallowing, regurgitation of food
What are complications of GERD?
long-term damage to esophagus
how can GERD be treated?
lifestyle changes
medication
diet changes
chronic recurring upper abdominal discomfort
dyspepsia (symptom not diagnosis)
a patient can be diagnosed with _____ if dyspepsia without other symptoms
functional dyspepsia
what are manifestations of dyspepsia?
burning pain, bloating, early satiety, gassiness, nausea
open sores form on mucosal membrane of the stomach or duodenum
peptic ulcer disease
what are causes of peptic ulcer disease?
NSAID use
H. pylori
gastrinomas
how is peptic ulcer disease treated?
medication
surgery
diet changes
how should macros be adjusted for patients with GERD, dyspepsia, and PUD?
carbs-avoidance of simple carbs and increase of fiber (mediterranean diet)
protein- nothing for or against
fats-high-fat and fried foods may trigger symptoms
What is patient diet education for GERD, dyspepsia, PUD?
avoidance of trigger foods:
generally acidic foods, spicy foods, gastric irritants, others
Avoid alcohol (can increase likelihood of peptic ulcer formation)
Dairy is associated with lower risk
CAM/herbals: curcumin, ginger, peppermint oil can relieve GI symptoms
Acidic foods: tomato-based foods, citrus foods, carbonated beverages
spicy foods: capsaicin-related
gastric irritants: coffee, tea, tobacco, alcohol, peppermint
others-fried or fatty foods, large meals, chocolate
what are lifestyle modifications for patients with GERD?
small, frequent meals
avoiding laying down flat after eating
elevating head of bed
quitting tobacco, alcohol, caffeine
avoiding tight clothing
weight loss of 10% or more (has most evidence to support)
foods high in non-digestable fiber that promote the growth of beneficial gut bacteria
prebiotics
food containing live commensal organisms associated with health benefits
probiotics
what are common strains of probiotics?
lactobacillus, bifidobacterium, saccharomyces, non-pathogenic strains of E-Coli
Lactobacilli often in dairy products
bifidobacterium growth encouraged by fructo-oligosaccharides
What is a negative aspect of probiotics?
wide variation in quality control of products, some may even have pathogenic bacteria
symptom based disorder characterized by one or more of the following: infrequent stools, hard stools, difficult stool passage
constipation
what can constipation be associated with?
-hemorrhoids
-diverticulosis
-anal fissures
Many potential causes
What is a cornerstone of constipation treatment?
increasing fiber intake with goal of 30 g/day
What foods can be good for constipation?
-fruit and vegetable fiber with good blend of soluble and insoluble fibers
-dried fruits particularly prunes (contain sorbitol), but may be associated with increased gas/bloating
-bran cereals, whole grain products
If a patient is not willing to eat naturally occuring fiber, what supplements can be used?
fiber additives: dextrin, methylcellulose, psyllium, calcium polycarbophil
what are side effects of fiber additives?
gas, bloating, flatulence, abdominal pain
If _____ is poor, constipation symptoms are still likely even with adequate fiber intake
hydration status
fiber increases stool bulk by absorbing water so goal intake is 1.5-2 L of fluid per day
what lifestyle modification/supplement can help with constipation?
physical activity
Probiotics (not strongly backed by evidence)
3 or more loose, watery stools per day
diarrhea
what are causes of diarrhea?
infection, inflammation, altered neurohormonal signals, altered GI secretions
when is diarrhea considered chronic?
if going on for greater than 4 weeks
if diarrhea is acute, what is the most likely cause?
infection
what are helpful dietary guidelines for diarrhea?
maintain hydration with electrolyte rich fluids
BRAT(Y) diet
Probiotics may help: often recommended prophylactically with abx
What is the BRAT (Y) diet?
Bananas, rice, applesauce, toast
+/- yogurt with active cultures, no added sugars, or artificial sweeteners
Not for long term chronic diarrhea because is not nutritionally complete
what are potential causes of chronic diarrhea?
infectious, medication-related, inflammatory, food intolerance, pancreatic disorders
What is recommended for chronic diarrhea?
low-FODMAP diet
what is low-FODMAP diet?
restricting fermentable oligosaccharides, disaccharides, monosaccharides, and polyols
–>thought to increase gas, bloating, and abdominal pain including sugar alcohols, wheat, milk, several fruits and veggies
temporary elimination diet where foods are removed and gradually re-introduced to see which foods are tolerated vs not
Probiotics but weak/limited evidence
