MNT for Lower GI Disorders Part 2

Inflammatory Bowel Disease (IBD)

A chronic and relapsing disorder of the GI tract characterized by chronic intestinal inflammation.

Types of IBD

Crohn's disease and ulcerative colitis.

Crohn's disease

A type of IBD that usually affects the small and large intestines but can occur anywhere along the GI tract.

Ulcerative colitis (UC)

A type of IBD that usually affects the large intestine and moves continuously from the rectum.

Similarities between Crohn's disease and ulcerative colitis

Both can cause diarrhea, fever, weight loss, anemia, food intolerances, malnutrition, growth failure, extraintestinal manifestations, and increased malignancy risk.

IBD flares

Periods of increased disease activity that may involve partial obstructions, nausea, abdominal pain, bloating, and diarrhea.

Extraintestinal manifestations of IBD

Symptoms outside the GI tract, including arthritic, dermatologic, and hepatic manifestations.

Ulcerative colitis characteristics

Bloody diarrhea, continuous inflammation beginning at the rectum, thin intestinal wall, few strictures, lower inflammation, deep ulcers, and higher risk of toxic megacolon.

Crohn's disease characteristics

Perianal disease, abdominal pain, discontinuous inflammation that can occur anywhere along the GI tract, thick intestinal wall, common strictures and fistulas, higher inflammation, shallow ulcers, and increased risk of malabsorption and malnutrition.

Fistula

An abnormal connection between two parts inside the body.

Stricture

An abnormal narrowing in a passage in the body.

Granuloma

A collection of immune cells.

Toxic megacolon

A serious complication associated with ulcerative colitis involving severe dilation of the colon.

Primary goal of MNT for IBD

Restore and maintain nutritional status.

MNT for IBD

Individualize nutrition care using foods, oral nutrition supplements, micronutrient supplements, and possibly enteral or parenteral nutrition.

Dietary modifications during IBD flares

Individualize based on food intolerances and symptoms; a low FODMAP diet may be trialed.

Enteral nutrition for IBD

Especially helpful in children during flares and may help temper inflammation.

Enteral nutrition in adults with IBD

Not typically first-line therapy.

Time needed to see effects of enteral nutrition

Approximately 4–8 weeks.

Energy needs for IBD

Overall energy needs are not substantially different from the general population.

Protein recommendation for IBD

1.3–1.5 g/kg/day.

Vitamins that may need supplementation in IBD

Folate, vitamin B6, and vitamin B12.

Minerals that may need supplementation in IBD

Iron, zinc, potassium, and selenium.

Corticosteroids and nutrient needs

Patients taking corticosteroids may need increased vitamin D and calcium.

Monitoring for patients with IBD

Routinely monitor 25-OH vitamin D levels and bone density.

Omega-3 fatty acids and IBD

Supplementation may decrease disease activity.

MNT during IBD flares

Lower fiber intake, drink plenty of decaffeinated and low-sugar beverages, eat small frequent meals, and possibly avoid high amounts of lactose, fructose, and fat.

Irritable Bowel Syndrome (IBS)

A common functional GI syndrome involving abdominal discomfort, altered intestinal motility, bloating, and changes in bowel habits.

IBS symptoms

Abdominal discomfort, feelings of incomplete evacuation, mucus in stool, straining, increased urgency, bloating, and GI distress with psychosocial distress.

IBS pathophysiology

Abnormal sensory and motor responses to various stimuli.

IBS classification

A functional disorder, not primarily an inflammatory disorder.

Common IBS triggers

Stress, coffee, alcohol, fat, insoluble fiber, large portions, FODMAPs, and possibly dairy or lactose.

IBS diagnosis

Celiac disease and Crohn's disease should be ruled out; diagnosis can then be based on symptoms and Rome IV criteria.

Rome IV criteria

Diagnostic criteria used to identify functional GI disorders, including IBS.

MNT for IBS

Ensure adequate nutrient intake, tailor the diet to the specific IBS pattern, and focus on symptom management.

Low FODMAP diet for IBS

May help reduce symptoms in some individuals.

Meal pattern for IBS

Eat meals and snacks on a regular schedule.

Fat intake and IBS

Lower-fat foods are typically better tolerated.

Psyllium husk for IBS-C

May help individuals with constipation-predominant IBS.

Soluble fiber for IBS-D

May be helpful for individuals with diarrhea-predominant IBS.

IBS-D

Diarrhea-predominant irritable bowel syndrome.

IBS-C

Constipation-predominant irritable bowel syndrome.

Medical management of IBS-D

May include antispasmodics, anti-diarrheals, and peppermint oil.

Medical management of IBS-C

May include laxatives.

Behavioral management of IBS

Cognitive behavioral therapy (CBT) and GI psychology.

IBS mimickers

Other conditions that can cause symptoms similar to IBS, including SIBO, congenital sucrase-isomaltase deficiency, bile acid malabsorption, pelvic floor dysfunction, histamine-mediated disorders, and nickel allergy.

Small Intestinal Bacterial Overgrowth (SIBO)

Excessive bacterial growth in the small intestine, defined in the notes as greater than 10³ colony-forming units/mL.

SIBO symptoms

Altered bowel patterns, fat and FODMAP intolerances, gas, and bloating.

SIBO distinguishing symptoms

Rapid onset of gas and bloating, often within an hour of eating trigger foods; may also involve unexplained weight loss and vitamin B12 deficiency.

SIBO etiology

May occur after bacterial gastroenteritis, Roux-en-Y gastric bypass or other small intestinal surgeries, atrophic gastritis, chronic proton pump inhibitor use, impaired small intestinal motility, intestinal inflammation, or low pancreatic fluid levels.

SIBO treatment

Antibiotics are the only evidence-based cure.

Diet and SIBO

No diet has been shown to cure SIBO or prevent recurrence; dietary changes can help manage symptoms while medical treatment is determined.

Low FODMAP diet for SIBO

May be used to manage symptoms.

Congenital Sucrase-Isomaltase Deficiency (CSID)

An enzyme deficiency that causes osmotic diarrhea.

CSID diagnosis

13C-sucrose breath test or disaccharidase activity testing through an endoscopy biopsy.

CSID treatment

Prescription sacrosidase enzyme with foods containing sucrose.

Low-sucrose diet for CSID

Very restrictive, excludes many fruits and vegetables, and is not recommended long-term.

CSID symptoms

Diarrhea, gas, and bloating, which can overlap with IBS symptoms.

CSID vs. IBS

CSID symptoms may worsen with a low FODMAP diet, may wake the patient overnight, and do not respond to anti-diarrheal medications.

Bile Acid Malabsorption

Occurs when bile acids are not properly absorbed in the ileum, causing the colon to secrete fluids.

Bile acid malabsorption treatment

Bile acid sequestrant medications.

Bile acid malabsorption vs. IBS

Both can cause diarrhea, gas, and bloating, but bile acid malabsorption may not respond to a low FODMAP diet or IBS medications and may cause sticky, tarry stools.

Pelvic Floor Dysfunction

Difficulty coordinating pelvic floor muscles, resulting in difficulty defecating.

Pelvic floor dysfunction symptoms

Hard stools, infrequent urges to defecate, frequent but unproductive urges, and abdominal distention.

Pelvic floor dysfunction treatment

Physical therapy, pharmacological options, and surgery.

IBS-C vs. pelvic floor dysfunction

Pelvic floor dysfunction may involve lack of response to laxatives, worsening symptoms with high fiber intake, and straining even when stools are soft.

MNT for pelvic floor dysfunction constipation

Choose soft foods, increase soluble fiber, decrease insoluble fiber, and include cooked and peeled fruits and vegetables, soups, smoothies, and purees.

Histamine-mediated disorder

A condition associated with deficiency of the diamine oxidase (DAO) enzyme in the gut.

Diamine oxidase (DAO)

An enzyme in the gut that helps break down histamine.

Histamine-mediated disorder symptoms

Acid reflux, dyspepsia, nausea, bloating, and abdominal pain.

Histamine-mediated disorder treatment

DAO enzyme supplements, a low-histamine diet, and antihistamine medications.

Histamine-mediated disorder vs. IBS

GI symptoms may occur alongside itching, brain fog, and rapid heart rate; symptoms may improve with antihistamine use.

High-histamine foods

Soybeans and soy-based foods, fermented, pickled and cured foods, wine, beer, yeast extract, shellfish, canned fish, leftover meats, aged steak, spinach, eggplant, tomatoes, avocado, and cherries.

Nickel allergy symptoms

Nausea, heartburn, abdominal distention, abdominal pain, diarrhea, and constipation.

Nickel allergy testing

Skin patch testing.

Nickel allergy treatment

Avoid high-nickel foods, limit canned foods, and use non-stainless cookware.

High-nickel foods

Chocolate, coconut, tree nuts, peanuts, seeds, oats, millet, buckwheat, raw whole grains, beans, lentils, peas, soy foods, and shellfish.

Other high-nickel foods

Dried fruits, raspberries, blackberries, apricots, plums, lychee, persimmons, and avocado.

High-nickel vegetables

Bean sprouts, asparagus, okra, sweet potato, taro, cassava, chayote, and seaweed.

High-nickel beverages

Tea, most protein drinks, and energy drinks.

Diverticular Disease

A condition involving the development of sac-like pouches in the colon and possible inflammation of those pouches.

Diverticulosis

The presence of sac-like pouches or herniations in the colon.

Diverticula

Sac-like pouches that form in the intestinal wall.

Possible causes or associations of diverticulosis

Chronic inflammation, changes in colonic sensorimotor function, abnormal colonic motility, low-fiber diets, and chronic constipation.

Diverticulosis symptoms

Typically asymptomatic.

Diverticulitis

Inflammation of diverticula (pouches) in the colon.

Diverticulitis pathophysiology

Food and bacteria can collect in the pouches, potentially causing inflammation.

Diverticulitis symptoms

Fever, abdominal pain, GI bleeding, and elevated white blood cell count.

MNT for diverticulosis

Follow a high-fiber diet, gradually increase fiber, use supplements if necessary, maintain adequate fluid intake, and participate in physical activity.

Nuts and seeds with diverticulosis

Restriction of nuts and seeds is no longer necessary.

MNT for active diverticulitis

If active bleeding occurs, patients are typically NPO and may require parenteral nutrition, followed by a low-fiber and possibly low-fat diet.

NPO

Nothing by mouth; withholding oral food and fluids.

Parenteral nutrition

Nutrition provided intravenously when the GI tract cannot be used adequately.