Lecture 10: GI Diet Flashcards
What is eosinophilic esophagitis? (EoE)
Chronic, allergic, inflammatory condition, with eosinophilic infiltration of the lining of the esophagus.
What characterizes EoE?
- Odynophagia
- Dysphagia
Resulting food impact, inability to eat, and reflux.
What are the long-term effects of EoE?
- Scarring
- Strictures
What are the suggested dietary modifications for someone with EoE?
- First-line: Elimination diet of milk.
- Second-line; 4FED (four-food elimination diet)
- SFED (six-food elimination diet), more conservative.
- Elemental diet (Nutrient-rich amino acid formulas)
What falls under a 4FED diet?
- Milk
- Wheat
- Eggs
- Soy
What is a SFED? What are the six?
Diet based on removing the 6 most common allergy-causing foods. No other diet restrictions.
* Milk
* Wheat
* Eggs
* Soy
* Peanuts/tree nuts
* Fish/shellfish
How efficacious is a SFED?
- Histologic response in 69%.
- Symptom response in 87%.
What is an elemental diet? What makes it up?
Diet based on nutrient-enriched amino acid formulas.
* Totally replace table food to meet nutritional need.
* Limiting flavoring/sweeteners
* 2-6 weeks only (SHORT PERIOD)
* They just eat amino acids mixed with sugars, fats, minerals, and vitamins.
Who usually does an elemental diet?
Children with EoE most commonly.
How efficacious is an elemental diet?
- Histologic response in 95%.
- Symptom response in 100%.
What is GERD?
Gastroesophageal Reflux Disease, characterized by recurrent retrograde acid reflux in the esophagus.
How is GERD typically described? What is the main concern with long-term GERD?
- Burning pain, shortly after eating
- Dysphagia
- Regurgitation of food.
Long-term damage to the esophagus
How do we treat GERD?
- Lifestyle changes
- Medications
- Diet changes
What is dyspepsia?
Chronic, recurring, upper abdominal discomfort. (symptom)
How is dyspepsia commonly described?
- Burning pain
- Bloating
- Early satiety
- Gassiness
- Nausea
What is peptic ulcer disease?
Open sore/ulcers that form on the mucosal membrane of the stomach for duodenum.
What are the MCC of PUD?
- NSAID use
- H. pylori
- Gastrinomas
How do we treat PUD?
- Medication
- Surgery
- Diet changes
What diet changes are recommended for GERD, dyspepsia, and PUD?
- Carbs: Avoid simple carbs and increase fiber (medi diet)
- Protein: no change
- Fats: High-fat foods and fried foods may trigger symptoms.
What should people with GERD, dyspepsia, and PUD avoid?
- Acidic foods (tomato-based, citrus, carbonated)
- Spicy (Capsaicin)
- Gastric irritants (Coffee, tea, tobacco, alcohol, peppermint)
- Others: fried/fatty foods, large meals, chocolate.
- Alcohol
- Dairy (fermented dairy = lower PUD risk)
- CAM/herbals (mixed evidence)
What are some simple lifestyle modifications can help with GERD?
- Small, frequent meals
- Avoiding laying flat after eating
- Elevating the head of the bed
- Avoid tobacco, alcohol, caffeine
- Avoid tight clothing
- Weight loss of 10% or more!
What are prebiotics?
Foods high in non-digestible fiber that promote the growth of healthy bacteria.
What are probiotics?
Food containing live commensal organisms associated with health benefits.
What are the commensal bacteria/yeast in probiotics?
- Lactobacillus
- Bifidobacterium
- Saccharomyces
- Non-pathogenic E. coli
What food usually has lactobaccilus?
Fermented dairy products.
What food usually has bifidobacterium?
Fructo-oligosaccharides (prebiotics)
What characterizes constipation?
1+ of the following.
* Infrequent stools
* Hard stools
* Difficult stool passage
What are the complications associated with constipation?
- Hemorrhoids
- Diverticulosis
- Anal Fissures
What is the cornerstone treatment for constipation?
30g/day of fiber, with an emphasis on fruit and veggie fiber.
What kind of fruit has a lot of fiber and sorbitol?
Dried fruits in general, but prunes specifically have sorbitol, which may cause increased gas and bloating!
Helps to pass stool easier but can have SE.
What are the fiber additives?
- Dextrin
- Methylcellulose
- Psyllium
- Calcium polycarbophil
- Often has associated SE of gas, bloating, flatulence, abd pain.
Often used for children who refuse to eat fiber.
What must be taken alongside fiber to ensure it works?
- Water hydration.
- Fiber specifically absorbs water into the GI lumen to increase stool bulk.
- You need 1.5-2L of water a day.
Are probiotics recommended for constipation?
NO
What is diarrhea? Chronic?
3+ loose OR watery stools a day.
Chronic is 4+ weeks.
What is the most common underlying etiology in acute diarrhea?
Infectious
How should we manage acute diarrhea?
- Electrolyte-rich fluids
- BRAT(Y) diet
- Probiotics may help
What is the BRAT(y) diet?
- Bananas
- Rice
- Applesauce
- Toast
- Yogurt (sometimes)
Yogurt must have active cultures, no additive sweetners.
How should we manage chronic diarrhea?
Trial a low-FODMAP diet.
What is a low-FODMAP diet?
- Fermentable Oligosaccharides
- Disaccharides
- Monosaccharides
- And Polyols.
You then slowly reintroduce these one by one to see which ones are tolerable.
Avoid artificial sweeteners long-term.
