Faculty of medicine

dr. Nurhasanah, Sp.GK

Riau University
Outline
1. Can explain possible nutritional
consequences cause of upper GI disorders
2. Can explain medical nutritional therapy on
upper GI disorders
3. Can explain possible nutritional
consequences cause of lower GI disorders
4. Can explain medical nutritional therapy on
upper GI disorders

2
Upper Gastrointestinal (GI) Tract
• Esophagus
• Stomach
• Duodenum
Lower GI Tract
• Small intestine
• Colon
• Rectum
3
NORMAL FUNCTION OF GI TRACT
• Digestion
• Absorption
• Excretion
NORMAL FUNCTION OF GI TRACT

 Digestion

– Begins in mouth & gaster

– Continues in duodenum & jejunum
– Secretions:
• Liver
• Pancreas
• Small intestine
SWALLOWING PROCESS
NORMAL FUNCTION OF GI TRACT
• Absorption
UPPER GASTROINTESTINAL
TRACT DISORDER
9
MEDICAL NUTRITION THERAPY
ON GERD AND ESOPHAGITIS

Objectives:

1. Decrease of esophagus to gastris content

2.  acidity of gastric secretion
3. Prevent pain & irritation of the inflamed
esophageal mucosa
Medical Nutrition Therapy on Surgery of
the mouth/esophagus cause of cancer
May be necessary to provide nutrition using liquid
supplements.
Patients who are unable to take adequate nutrition
orally for an extended time
 gastrostomy tube placement
 The enteral route of nutrition is preferred

If the GIT is not functional  parenteral

nutrition can be provided
 13
Management on gastritis and
peptic ulcer
FREQUENT SMALL MEALS MAY:
 comfort
 the chance for acid reflux
stimulate gastric blood flow

persons w/ peptic ulcers should avoid

consuming large meals, esp. before
retiring, to reduce latent increases
in acid secretion
Side effects of chronic acid
suppression

 either from disease or chronic use of acid-

suppressing medication such as PPIs
 reduction of gastric secretion of HCl and
intrinsic factor  reduce absorption of nutrients
such as B12, calcium, and nonheme iron
 may increase incidence of some bone
fractures, increase risk for intestinal infection
(gastric acidity is a front-line barrier to microbial
invasion).
 CARCINOMA OF THE STOMACH

 Consumption of fruits, vegetables, and

selenium appears to have a modest role in
the prevention of GI cancers
 Increased the risk : alcohol consumption and
overweight, chronic infection with H.
pylori, smoking, intake of highly salted or
pickled foods, or inadequate amounts of
micronutrients
Nutrition therapy for carcinoma of
stomach
 The patient with advanced, inoperable cancer
should receive a diet that is adjusted to his or
her tolerances, preferences, and comfort.
 Anorexia is almost always present from the early
stages. In the later stages of the disease, the
patient may tolerate only a liquid diet.
 If a patient is unable to tolerate oral feeding 
alternate route  gastric or intestinal feeding
tube
 In the case of the inability to feed enterally 
parenteral nutrition
GASTRIC SURGERIES
Postoperative medical nutrition
therapy

 oral intake of foods & fluids is initiated as

soon as it is determined that the patient's
GIT is functioning.
 Small, frequent feedings of water are
initiated  followed by liquids and easily
digested solid foods, after which the
patient can progress to a regular diet.
Postoperative Medical
Nutrition Therapy
 the patient may be
fed through a feeding
tube, such as a
jejunostomy if the
surgery requires an
extended period for
healing, or the patient
is unable to tolerate
an oral diet
 GASTRIC SURGERIES

 Complications such as obstruction, dumping,

abdominal discomfort, diarrhea, and weight loss
may occur.
 Over the long term, anemia, osteoporosis, and
select vitamin and mineral deficiencies may occur
as a result of malabsorption or limited dietary
intake
 Vitamin B12 deficiency may cause a megaloblastic
anemia  after gastrectomy patients should
receive prophylactic vitamin B12 supplementation
(injections) / take synthetic oral
supplementation
 DUMPING SYNDROME

 Is a complex GI and vasomotor response to the

presence of larger-than-normal quantities of
hypertonic foods and liquids in the proximal small
intestine.
 Usually occurs as a result of surgical procedures that
allow excessive amounts of liquid or solid foods to
enter the small intestine in a concentrated form
 Early dumping is characterized by both GI and
vasomotor symptoms
 Late dumping is predominantly characterized by
vascular symptoms.
 DUMPING SYNDROME

 In early dumping  patients may experience

abdominal fullness and nausea within 10-30 minutes
of eating a meal
 In the intermediate stage, from 20 mnts - ≥ 1 hours
after eating  abdominal bloating, increased
flatulence, crampy abdominal pain, and explosive
diarrhea.
 Late dumping, occurring from 1 - 3 hours after a
meal  flushing, rapid heartbeat, faintness, and
sweating, and feel the need to sit or lie down. They
may feel anxious, weak, shaky / hungry, and have
difficulty concentrating.
Nutritional Management
 LOWER
GASTROINTESTINAL TRACT
DISORDER
COMMON INTESTINAL
PROBLEMS
◦ Intestinal gas & flatulence
◦ Constipation
◦ Diarrhea
◦ Steatorrhea
◦ Gastrointestinal stricture &
obstruction
Instestinal Gas & Flatulence
Causes:
 Inactivity
  GI motility
 Aerophagia
 Dietary components
 GI disorders

27
Medical nutrition therapy on
Instestinal Gas & Flatulence
• Aerophagia can be avoided by eating slowly,
chewing with the mouth closed, limiting gum
chewing, and refraining from drinking through
straws.
• Movement of gas through the GIT may be
enhanced with upright stance, mild exercise, or
abdominal massage.

28
Medical nutrition therapy on
Instestinal Gas & Flatulence
• CONSUMPTION OF LARGE AMOUNTS OF DIETARY
FIBER, RESISTANT STARCHES, HIGH CHO, LACTOSE
IN PERSONS WHO ARE LACTASE DEFICIENT OR
MODES AMOUNTS OF FRUCTOSE OR SUGAR
ALCOHOLS INCREASED GAS DAN FLATULENCE

29
Constipation
Most common causes:
Ignoring the urge to defecate
Lack of fibre in the diet
Insufficient fluid intake
Inactivity
Chronic use of laxatives

30
Box 29-1
 Medical Nutrition Therapy
• Fiber + fluids
• Dietary fiber:
–high in prebiotics, substances that are not
digested by humans and fuel colonic
microflora
–Role: soluble and insoluble for increases colonic
fecal fluid, microbial mass, stool weight and
frequency and the rate of colonic transit
–25 grams perday
 FIBER IN FOODS
100 g Oatmeal = 10 g
100 g beras merah = 1,8 g
100 g beras putih = 0,4 g
100 g apel ( ½ buah ) = 2,4
100 g pisang ( 1 buah) = 2,6 g
100 g pepaya ( ¼ buah) = 1,8
100 g kangkung = 1,9 g
100 g bayam = 2,2 g
DIARRHEA

35
MEDICAL NUTRITION
THERAPY
 First step is replacement fluids and electrolytes
 Sugar, alcohols, lactose, fructose and
sucroseworsen osmotic diarrhea
 Providing fiber to patients with diarrhea does
increase the volume of stool, and in some cases can
initially increase gas and bloating.
 Modest intake of prebiotic components and
soluble fibers such as pectin or gum slows
transit through the GIT.
36
MEDICAL NUTRITION THERAPY

MCTs can be given on steatorrhea because:

able to enter the portal vein for transport to the
liver without micelle formation digestion &
absoprtion, & resynthesis into triglycerides in
intestinal cell

easier to be absorbed in the abscense of

bile acids
Micronutriens supplementation: Fat-soluble vitamins,
Ca, Zn, Mg
 39
GASTROINTESTINAL STRICTURE
&OBSTRUCTION

 CELIAC DISEASE (GLUTEN-SENSITIVE

ENTEROPATHY)

 LACTOSE INTOLERANCE

 INFLAMMATORY BOWEL DISEASE

CELIAC DISEASE (GLUTEN-
SENSITIVE ENTEROPATHY)
 42
LACTOSE INTOLERANCE

 alleviated by reduced consumption of

lactose-containing foods
 Persons who avoid dairy products may need
calcium and vitamin D supplementation or
must be careful to get nondairy sources of
these nutrients.
Tabel 29-3
 Segments of inflamed bowel

Crohn’s disease Ulcerative colitis

INFLAMMATORY BOWEL
DISEASE
Risk factors associated w/ the onset of
exacerbations of IBD include:

  sucrose intake
 lack of fruits & vegetables
 dietary fibre <<
 red meat >>
 alcohol
 altered n-6/n-3 fatty acid ratios
REFERENCES

Mahan LK, Escott-stump S, Raymond JL. Krause’s

Food & The Nutrition Care Process, 14th ed. USA:
Elsevier Saunders; 2017
M.E. Shils et al. Modern Nutrition in Health and
Disease, 12th ed. USA: Elsevier Saunders; 2017
Visschers R, Gemert W van, Soeters PB.
Nutrition and Gastrointestinal Fistulas. In:
Nutritional Support in Gastrointestinal Disease.
ESPEN LLL; 2013:1-13.

48
49