Dietary management of GI disease Flashcards
where is IBD most common?
in developed countries
UK, USA, Australia etc
what are the risk factors for IBD?
Vit D deficiency stress smoking diet sleep medications genetic appendectomy microbiome hygiene physical activity
what are the clinical features of crohns?
abdominal pain diarrhoea malaise, fever anorexia & weight loss (deeper, more associated with fistula and stricture)
what are the clinical features of ulcerative colitis?
bloody diarrhoea
colicky abdominal pain
urgency
how common is protein-energy malnutrition in IBD?
20-85% (esp crohns in small intestine)
where is the majority of absorption undertaken?
small bowel
where does ulcerative colitis mainly affect?
large intestine
so more hydration and electrolyte issues
what are the 4 stages of IBD management?
food first & symptom control
nutritional support via ONS or EN
elemantel module and semi-elemental options
Pre/post op PN & HPN
is enteral nutrition used in UC?
no
only useful in CD (not as useful as steroids in adults)
what is module?
product used as sole nutrition or supplement to diet
contains naturally occurring anti-inflammatory
helps to treat the disease and put it into remission if patient is compliant
does parenteral nutrition induce remission in UC or CD?
no
may be useful pre-op
when is TPN useful?
extensive active disease within small bowel
.
.
.
is malnutrition more common in CD or UC?
crohns
what is the best treatment for IBD?
…
what is the most common digestive condition?
IBS
what are the possible common causes of IBS?
related to visceral hypersensitivity
can be linked to previous GI disease
stress
what is rome IIII criteria?
recurrent abdo pain on average 1 day per week in the last 3 months + 2 of:
- related to defecation
- associated with change in frequency of stool
- associated with change in stool form
symptoms must have started 6 months ago
what can be mistaken for IBS?
coeliac disease
ovarian cancer
bowel cancer
what is the first line dietary advice for IBS?
3 regular meals a day (smaller meals, chew more)
limit alcohol intake (max 2 unite per day)
Ensure adequate fluid intake (6-8 drinks per day)
Limit caffeine (max 3 cups per day)
Limit fizzy drinks
Cut down on rich/fatty foods and processed meals
Take time to relax
Limit fresh fruit to 3 portions a day
Food and symptoms diary can be helpful
what other considerations are taken into account for IBS?
reduce gas producing foods
increase fibre for constipation, reduce for diarrhoea
avoid sugar free things (contain polyols)
Could trial probiotics (daily for 4 weeks)
Check for food intolerances (milk/lactose mainly)
what is second line dietary advice for IBS?
low FODMAP diet
how do fodmaps trigger symptoms?
fermentable carbohydrates should be digested and absorbed higher up in small intestine but reach large intestine so the gut draws water into the gut and gas produced as bacteria attack the carbohydrates causing luminal digestion and the classic symptoms
is the low FODMAP diet long term?
no
only used short term (2-6 weeks) as investigative tool
reintroduction phase of FODMAPs to identify triggers and tolerance levels
Long term self management
how successful is low FODMAP diet?
75%
what kind of disease is coeliac?
life-long autoimmune
how common is coeliac disease?
1 in 100
but only 24% are diagnosed
what are the symptoms of coeliac disease?
stomach pain anaemia diarrhoea nausea & vomiting lots of gas and bloating TATT and fatigue can have no gut symptoms
when is coeliac disease usually diagnosed?
adulthood
all suspected IBS patients should be screened for celiac disease, true or false?
true
what is the requirement for an anti TTG test to be performed?
gluten in diet for 6 weeks
