Nutrition and GI Disease

Question 1

What % of patients with IBD have each of the separate disease?

Answer 1

2/3rds = ulcerative colitis
1/3rd = Chron’s disease
(approximately)

Question 2

Clinical features of Crohn’s?

Answer 2

Abdo pain
Diarrhoea
Anorexia and weight loss
Malaise and fever

Question 3

Clinical Features of Ulcerative colitis?

Answer 3

Bloody diarrhoea
Colicky abdominal pain
Urgency
Prevalence of obesity in ulcerative colitis patients is increasing

Question 4

What may type of diet may IBD be related to?

Answer 4

Western diet (sugar and fats) - caused by changes in diet leading to alteration of intestinal microbiological flora rather than specific antigens in food

Question 5

Why do IBD patients becomes malnourished? (3)

Answer 5

nutrient loss
increased requirement due to catabolic effect of inflammation
decreased intake e.g. due to pain)

Question 6

What dietetic assessment

Answer 6

MUST assessment
Frequency of bowel movements
investigations
medications
detailed diet history
*MDT approach

Question 7

Dietary advice given to patients with IBD?

Answer 7

nutritional support (high calorie and protein diet, little and often, supplement drinks)
Food avoidance (food intolerance unusual but sometimes they can become intolerant to lactose for example)
Possible triggers?

Question 8

What must be continually monitored in IBD patients?

Answer 8

Nutrient levels e.g. do they require vitamin. mineral supplements

Question 9

What is the second line of nutrition if oral route is insufficient

Answer 9

Enteral nutrition:
No role in treatment of UC
Alters inflammatory response in CD therefore may be useful

Question 10

What is the most effective way for inducing remission in IBD?

Answer 10

Steroids

Question 11

Parenteral nutrition in IBD?

Answer 11

Not a lot of indications for this apart from when the GI tract is not working

Question 12

Dietary advice for UC?

Answer 12

Same as general population

Question 13

What is the diagnoses criteria for IBS?

Answer 13

Rome III - recurrent abdo pain or discomfort at least 3 days per month in the last 3 months. Associated with 2 or more of the following:
Pain relieved by bowel movement
Onset of pain is related to frequency of stool
Onset of pain is related to a change in the appearance of the stool

Question 14

Medications for IBS

Answer 14

Anti-spasmodics
Anti-muscarinics
Anti motility drugs
Laxatives
Bulking agents, antispasmodics and antidepressants for the treatment of IBS

Question 15

Initial Dietary advice for IBS

Answer 15

Regular meals
Limit alcohol
Ensure adequate fluid intake
LiMIT caffeine intake

Question 16

2nd stage dietary advice for IBS?

Answer 16

Adjust fibre intake depending on diarrhoea or constipation
Limit fruit juice/ fizzy juice
limit sorbitol
limit resistant starch
trial probiotics
lactose free diet
wheat free diet
elimination diet

Question 17

3rd advice for IBS?

Answer 17

FODMAP diet

Question 18

What are FODMAPs

Answer 18

Short chain carbs

poorly absorbed leading to fermentation and osmotic changes in the bowel

Question 19

Treatment for coeliac disease?

Answer 19

Gluten-free diet

Question 20

What contains gluten?

Answer 20

Wheat, barley and rye

Question 21

Can oats be eaten if you have coeliac?

Answer 21

Oats can usually be eaten (they have a very small amount of gluten in them so if you try them and don’t tolerate them you will need to stop eating them)

Question 22

What can coeliac patients be prescribed?

Answer 22

Gluten free food

Question 23

What disorder at coeliac patients at risk of?

Answer 23

Osteoporosis (malabsorption of calcium) -> less chance the earlier you start a gluten free diet