SAS # 18: Foods and Food Consistency for Upper GI Disorders; Fiber-Modified Diets for Lower Gastrointestinal Tract Disorders

Mechanically Altered Diets

these diets modify food texture or consistency and are recommended for individuals with chewing or swallowing difficulties. Foods are typically liquid, pureed, ground, chopped, minced, or soft.

Blenderized Diet

Most often recommended following oral or facial surgeries (e.g., jaw wiring). Foods from all groups can be included (cooked tender meats, boiled rice, fruit without skins/seeds). Hard or rubbery foods like nuts, seeds, dried fruit, hard cheese, and some raw vegetables should be excluded as they do not blend well.

Clear Liquid Diet

This diet consists of foods that are liquid at room temperature, require minimal digestion, and leave little residue (undigested material) in the colon.

Clear Liquid Diet Indication

Often recommended before or after certain GI procedures (examinations, X-rays, or surgeries), or after fasting or intravenous feeding.

the nutrient and energy contents are extremely limited. As such if used longer than one or 2 days, commercially prepared low-residue formulas are needed for supplementary.

What is the disadvantage of  Clear Liquid Diet?

Full Liquid Diet

A liquid diet that includes milk and other opaque liquids (such as fruit nectars, yogurt, and oral supplements). It is rarely necessary but is sometimes used as a transitional diet.

Dry mouth, Dysphagia, GERD

Conditions Affecting the Mouth and Esophagus

Dry Mouth (Xerostomia)

Caused by reduced salivary flow. It is a side effect of many medications, and associated with conditions like poorly controlled diabetes and Sjögren’s syndrome.

Dry Mouth (Xerostomia) Consequences

Impairs speaking and swallowing, increases risk of mouth infections, bad breath, and dental diseases. It can diminish taste sensation and cause pain when consuming salty or spicy foods, potentially increasing malnutrition risk due to reduced food intake.

Dry Mouth (Xerostomia) Dietary Tips

Frequent sips of water or sugarless beverages, sucking on ice or frozen fruit juice bars, and consuming foods with high fluid content (soups, stews, sauces, yogurt). Avoid dry foods (toast, chips) and irritants like citrus juices or spicy/salty foods.

Dysphagia (Difficulty Swallowing)

Caused by problems with swallowing muscles or a physical obstruction.

Oropharyngeal Dysphagia

Difficulty transferring food from the mouth/pharynx to the esophagus. Typically due to a neuromuscular disorder. Symptoms include inability to initiate swallowing, coughing during or after swallowing (due to aspiration), and nasal regurgitation.

Esophageal Dysphagia

Difficulty passing materials through the esophageal lumen. Usually due to an obstruction (stricture, tumor) or a motility disorder.

Esophageal Dysphagia main symptom

is the sensation of food “sticking” in the esophagus. Obstructions often affect solid foods but may not affect liquids, while motility disorders hinder the passage of both solids and liquids.

Esophageal Dysphagia Complications

Malnutrition, weight loss, dehydration (if liquids cannot be swallowed), and aspiration, which may cause choking or pneumonia.

Dysphagia Diet Level 1 (Pureed)

Dysphagia Diet Level:

• Pureed/well mashed, homogeneous, and cohesive.

• Moderate to severe dysphagia and poor oral or chewing ability

Dysphagia Diet Level 2 (Mechanically Altered)

Dysphagia Diet Level:

• Moist, cohesive, soft texture, easily forms a bolus.

• Moderate to severe dysphagia; some chewing ability is required.

Dysphagia Diet Level 3 (Advanced)

Dysphagia Diet Level:

• Moist, bite-sized pieces; foods with mixed textures are included.

• Mild dysphagia and adequate chewing ability.

Thin

Liquid Consistencies: Watery fluids (water, coffee, juices).

Nectarlike

Liquid Consistencies: Thicker than water; can be sipped through a straw (buttermilk, cream soups).

Honeylike

Liquid Consistencies: Can be eaten with a spoon but does not hold shape (honey, some yogurts).

Spoon-thick

Liquid Consistencies: Thick fluids that must be eaten with a spoon and can hold shape (milk pudding, thickened applesauce).

Gastroesophageal Reflux Disease (GERD)

Characterized by frequent reflux (backward flow) of the stomach’s acidic contents into the esophagus, causing pain and inflammation (heartburn or acid indigestion). Cause by weakness or inappropriate relaxation of the lower esophageal sphincter (LES). Other factors include obesity, pregnancy, and hiatal hernia.

Reflux esophagitis and Barrett’s esophagus

What are the 2 Consequences Gastroesophageal Reflux Disease (GERD)

Reflux esophagitis

Inflammation in the esophagus.

Barrett’s esophagus

Esophageal cells damaged by chronic acid exposure are replaced by abnormal cells, which sometimes become cancerous.

Small meals

For managing GERD: Consume only _____and drink liquids between meals to prevent stomach over-distention.

lying down after meals, 3hours

For managing GERD: Avoid eating bedtime snacks or _____(meals should be consumed at least ____hours before bedtime).

Dyspepsia and Gas, Gastritis, Peptic Ulcer Disease (PUD)

Conditions Affecting the Stomach

Dyspepsia

General term for pain or discomfort in the upper abdominal area, often called "indigestion".

Bloating and Stomach Gas

Often caused by air swallowing, which occurs with gum chewing, smoking, rapid eating, drinking carbonated beverages, and using a straw.

Gastritis

Inflammation of the gastric mucosa. Most cases result from Helicobacter pylori infection or NSAID use.

Acute Gastritis

Gastritis that typically results from irritating substances, leading to tissue erosions, ulcers, or hemorrhaging.

Chronic Gastritis

Gastritis that may be caused by long-term infection or autoimmune disease; can lead to widespread inflammation, tissue atrophy, and is a risk factor for gastric cancer.

Hypochlorhydria or Achlorhydria

what is the 2 common Complications of Gastritis

Hypochlorhydria

abnormally low gastric acid

Achlorhydria

absence of gastric acid, A form of atrophic gastritis associated with achlorhydria can lead to Pernicious anemia

Pernicious anemia

a vitamin B12 deficiency, occurs when the body cannot absorb vitamin B12 due to a lack of intrinsic factor (IF), a protein produced by stomach cells that binds B12 for absorption in the small intestine.

A. avoided for 24–48 hours

Gastritis Dietary Interventions: If pain/vomiting occurs, food intake may be (A. avoided or B. eaten) and for how many hours to rest the stomach.

Peptic Ulcer Disease (PUD)

An open sore in the GI mucosa caused when gastric acid and pepsin overwhelm mucosal defenses.

H. pylori infection (present in 30–90% of cases) and NSAID use

Primary Factors that causes PUD

Peptic Ulcer Disease (PUD) Symptoms

Pain experienced as a hunger pain, gnawing, or burning sensation in the stomach region.

Duodenal ulcers

A type of PUD that may be relieved by food and recur several hours later.

Gastric ulcers

A type of PUD that may be aggravated by food and cause appetite loss.

GI bleeding

complication in PUD that is evidenced by black, tarry stool or "coffee grounds" vomit

GI bleeding, perforations, and gastric outlet obstruction

Complications of PUD

2 Hours

PUD Nutrition Care: Patients should avoid food consumption for at least how many hours before bedtime?

Fiber intake

Can be modified to increase or decrease stool weight and transit time.

Disorders of Bowel Function

Constipation, Diarrhea

Constipation

Defined by a defecation frequency of fewer than three bowel movements per week. Due to Low-fiber diet, low food intake, inadequate fluid intake, or low physical activity level.

25 grams

Primary treatment for Constipation: is a gradual increase in fiber intake to at least how many grams per day?

Other Measures for Constipation

Consume adequate fluid (1.5 to 2 liters daily). Adding prunes or prune juice is recommended due to their mild laxative effect. Fiber supplements like methylcellulose (Citrucel) and polycarbophil (Fiber-Lax) do not increase intestinal gas.

Diarrhea

Characterized by the passage of frequent, watery stools, leading potentially to dehydration and electrolyte imbalances.

Osmotic Diarrhea

Unabsorbed nutrients attract water to the colon (e.g. high intakes of poorly absorbed sugars or lactase deficiency).

Secretory Diarrhea

Fluid secreted by the intestines exceeds the amount reabsorbed (often due to foodborne illness or inflammation).

low-fiber, low-fat, lactose-free diet

Nutrition Therapy for diarrhea: Often involves what type of diet to limit stool volume?

Caffeine stimulates GI motility

why should patients avoid caffeinated coffee and tea when they are experiencing diarrhea?

Irritable Bowel Syndrome (IBS)

Chronic, recurring intestinal symptoms (diarrhea and/or constipation), flatulence, and abdominal pain that cannot be explained by specific physical abnormalities. Structurally normal however functionally isn’t working as it should be (abnormal).

fried/fatty foods, gas-producing foods, milk products, wheat products, and coffee

Foods that may aggravate symptoms of IBS

Inflammatory Bowel Diseases (IBD)

refers to chronic, relapsing inflammation of the gastrointestinal tract which includes Crohn’s disease and Ulcerative Colitis.

Crohn’s Disease

Inflammation typically affects the ileum and/or large intestine, but can occur anywhere in the GI tract. The inflammation pervades the entire intestinal wall. Characterized by "skip" lesions (normal tissue separating affected regions). Complications include ulcerations, strictures, obstructions, and fistulas.

Ulcerative Colitis (UC)

Involves the rectum and colon only. Inflammation is continuous and affects only the mucosa and submucosa (the inner layers closest to the lumen). Symptoms include frequent, urgent bowel movements with blood and mucus.

High calorie and high protein diet

Nutrition Therapy for IBD: The diet prescribed to prevent malnutrition and promote healing.

low-fiber, low-fat diet

Nutrition Therapy for IBD: During exacerbations, the diet that is provided in small, frequent feedings that can minimize stool output and malabsorption symptoms.

Colostomies and Ileostomies

An ostomy is a surgically created opening (stoma) in the abdominal wall for waste elimination. What are the 2 types?

Colostomy

Stoma formed from a section of the colon.

semi-solid

Stool consistency in Colostomy

Ileostomy

Entire colon is removed or bypassed, and the stoma is formed from the ileum.

liquid

Stool consistency in Ileostomy

low-fiber diet

Nutrition Care for Ostomies during General Post-Surgery: Diet progresses from clear liquids to regular foods; This diet may be recommended to reduce stool output.

Ileostomy Specific Concerns

Patients must chew thoroughly to prevent obstructions, which are a primary concern due to the small ileal lumen. Foods high in insoluble fibers may be discouraged. Patients should use salt liberally and ingest beverages with added electrolytes (e.g., sports drinks) to replace fluid and electrolyte losses. Vitamin B12 injections may be required if a large portion of the ileum was removed

Hard, chewy, and hard to digest fibers (include celery, coconut, nuts, seeds, popcorn, dried fruit, pineapple, and tough, chewy meat)

Obstruction-Causing Foods (Ileostomy)

Foods that may cause unpleasant odors

asparagus, broccoli, cabbage, eggs, fish, garlic, and onions.

Foods that may help reduce odors

buttermilk, cranberry juice, parsley, and yogurt.

Stool Thickening Foods

Applesauce, banana, cheese, pasta, potatoes, smooth peanut butter, and white rice.