Nutritional Management of patients with

gastrointestinal disorders
Outline
• Introduction
• Disorders of the GIT Organs
1. Dyspepsia
2. Esophagitis
3. Hiatal hernia
4. Peptic Ulcers
5. Diverticulosis
6. Inflammatory bowel diseases
7. Celiac disease
8. Other disorders
• Residue-Controlled Diets
1. The High-Fiber Diet
2. The Low-Residue Diet
Disorders of the GIT
Organs
 Dyspepsia(indigestion)
It is a feeling of burning, pain, or discomfort in the digestive
tract. It can result from a medical condition, lifestyle factors
or psychological in origin.
 Esophagitis
Caused by the irritating effect of acidic gastric reflux on
the mucosa of the esophagus.
(heartburn, regurgitation, and dysphagia )
 Hiatal hernia
A condition in which a part of the stomach protrudes
through the diaphragm into the thoracic cavity.

Symptoms:
▪ Heartburn
▪ Regurgitation.
 Nutritional interventions to decrease
these symptoms
• Serving small, frequent meals (from a well-balanced diet)
so that the amount of food in the stomach is never large.

• Avoid irritants to the esophagus such as carbonated

beverages, citrus fruits and juices, tomato products, spicy
foods, coffee, pepper, and some herbs.

• Some foods can cause the lower esophageal sphincter to

relax, and these should be avoided. Examples are alcohol,
garlic, onion, oil of peppermint and spearmint, chocolate,
cream sauces, margarine, butter, and oil.
 Nutritional interventions to decrease
these symptoms
• If the client is obese, weight loss may be recommended to
reduce pressure on the abdomen.

• Instruct the patient to:

✓ Avoid late-night dinners.

✓ lying down for 2 to 3 hours after meal.

✓Wear loose-fitting clothing.

 Peptic Ulcers
• It is a condition in which painful sores or ulcers develop in the lining
of the stomach or the first part of the small intestine (the duodenum).
• Normally, a thick layer of mucus protects the stomach lining from the
effect of its digestive juices. But many things can reduce this
protective layer, allowing stomach acid to damage the mucosal
tissue.
• Symptoms: gastric pain (burning) relieved with food or antacids and
hemorrhage.
 Nutritional interventions to decrease
peptic ulcer symptoms:
• The amount of fat in the diet should be decreased.

• Sufficient low-fat protein should be provided because of

its ability to stimulate gastric acid secretion.
• It is recommended that the patient receives 0.8 gram of
protein per kilogram of body weight. However, if there has
been blood loss, protein may be increased to 1 or 1.5
grams per kilogram of body weight.

• Vitamin and mineral supplements, especially iron if

hemorrhage present.
Nutritional interventions to decrease
peptic ulcer symptoms:
• Carbohydrates have little effect on gastric acid
secretion.
• Spicy foods should be avoided.
• Coffee, tea or anything else that contains caffeine
or that seems to cause indigestion in the client or
stimulates gastric secretion should be avoided.
• Alcohol and aspirin irritate the mucous
membrane of the stomach, and cigarette smoking
decreases the secretion of the pancreas that
buffers gastric acid in the duodenum.
 Diverticulosis
is an intestinal disorder characterized by presence of
pockets in the sides of the large intestine.

diet lacking sufficient fiber make fecal matter

collects in these pockets instead of moving on
through the colon, causing diverticulitis
 Nutritional interventions for
diverticulitis:
• Begin with a clear liquid diet.

• Followed by a low-residue diet that allows the

bowel to rest and heal.
• Then a high-fiber diet will be a initiated.
• The bulk provided by the high-fiber diet increases
stool volume, reduces the pressure in the colon,
and shortens the time the food is in the intestine,
giving bacteria less time to grow.
 Inflammatory bowel diseases (IBDs)

• Chronic conditions causing inflammation in the

gastrointestinal tract.
• The inflammation causes malabsorption that often leads
to malnutrition.
• The acute phases of these diseases occur at irregular
intervals and are followed by periods in which clients are
relatively free of symptoms.
• Neither cause nor cure for these conditions is known.
IBD and body systems
 Nutritional interventions for inflammatory bowel
disease

• Low-residue diet is required to avoid irritating the

inflamed area and to avoid the danger of obstruction.
• When tolerated, the diet should include about 100
grams of protein, additional calories, vitamins, and
minerals.
• In severe cases, total parenteral nutrition (TPN) (a
process in which nutrients are delivered directly into
the superior vena cava may be necessary for a period
Celiac disease, also called gluten sensitivity

a disorder in the lining of small intestine

characterized by malabsorption of virtually all
nutrients. It is thought to be due to heredity
Nutritional interventions for celiac disease

• A gluten-controlled diet is used in the treatment of celiac

disease.
• Gluten is a protein found in barley, oats and wheat. ‫الشعير‬
‫والشوفان والقمح‬
• All products containing these grains are disallowed. Rice and
corn may be used.
• A reduction in the fiber content is also frequently
recommended.
• If the client is under weight, the diet should also be high in
calories, carbohydrates, and protein.
• Fat may be restricted until bowel function is normalized.
• Vitamin and mineral supplements may be prescribed.
Nausea
• Eat dry crackers ‫المقرمشات‬or dry toast before rising.
• Eat small and frequent meals.
• Avoid foods with offensive odors.
• Avoid liquids at mealtime.
Constipation
• Constipation and hemorrhoids can be relieved by eating high-
fiber foods.
• drinking at least 8 glasses of liquid each day
Heartburn
• Eating small and frequent meals.
• Avoiding spicy or greasy foods.
• Avoiding liquids with meals
• Waiting at least an hour after eating and
before lying down
• Waiting at least 2 hours before exercising.
Pancreatitis
Symptoms
• Abdominal pain, nausea, and steatorrhea
• Malabsorption (particularly of fat-soluble
vitamins) and weight loss occur
• in cases in which the islets of Langerhans
are destroyed, diabetes mellitus may
result
Nutritional interventions for Pancreatitis

• Diet therapy is intended to reduce pancreatic secretions and

bile. Just as fat stimulates the gallbladder to secrete bile,
protein and hydrochloric acid stimulate the pancreas to
secrete its juices and enzymes.
• During acute pancreatitis, the client is nourished strictly
parenterally.
• Later, when the client can tolerate oral feedings, a liquid diet
consisting mainly of carbohydrates is given
• Carbohydrates have the least stimulatory effect on
pancreatic secretions.
Nutritional interventions for Pancreatitis

• As recovery progresses, small, frequent feedings

of carbohydrates and protein with little fat or
fiber are given.
• The fat is restricted because of deficiencies of
pancreatic lipase.
• The client is gradually returned to a less
restricted diet as tolerated.
• Vitamin supplements may be given.
• Alcohol is forbidden in all cases.
Residue-controlled diets
• Residue is the solid part of feces.
• Residue is made up of all the undigested
and unabsorbed parts of food, connective
tissue in animal foods, dead cells, and
intestinal bacteria and their products.
• Most of this residue is composed of fiber.
• Diets can be adjusted to increase or
decrease fiber and residue depend on
client's condition.
Residue-controlled diets
• Fiber is that part of food that is not broken
down by digestive enzymes.
• It is called dietary fiber.
• Most dietary fiber is found in plant foods.
• Some is soluble and some is insoluble.
• Examples of dietary fiber in plants include
seeds of strawberries and the connective
tissue of citrus fruits..
The High-Fiber Diet
• A high-fiber diet is often 25 to 35 grams.
• It believed to help prevent diverticulosis,
constipation, hemorrhoids, and colon
cancer.
• They also are helpful in the treatment of
diabetes mellitus and atherosclerosis.
The High-Fiber Diet
• It include whole-grain breads and cereals,‫حبوب‬
bran ‫نخاله‬, all fruits, vegetables (especially raw),
and legumes.
• High-fiber diets must be introduced gradually to
prevent the formation of gas and the discomfort
that accompanies it.
• Eight glasses of water also must be consumed
along with the increased fiber.
• Milk, meats, and fats do not contain fiber
The Low-Residue Diet
• The low-residue diet of 5 to 10 grams of dietary
fiber a day is intended to reduce the normal work
of the intestines by restricting the amount of
dietary fiber and reducing food residue.
• Low-fiber or residue-restricted diets may be used
in cases of severe diarrhea, diverticulitis, ulcerative
colitis, and intestinal blockage and in preparation
for and immediately after intestinal surgery.
 The Low-Residue Diet
• In some facilities, these diets consist of foods
that provide no more than 3 grams of fiber a
day and that do not increase fecal residue.
• Some foods that do not actually leave residue
in the colon are considered “low- residue”
foods because they increase stool volume or
provide a laxative effect.
• Milk and prune juice are examples. Milk
increases stool volume, and prune juice acts as
a laxative.