Lower GI Disorders

GI Disorders
Lower GI

I Irritable Bowel Syndrome (IBS) (syndrome = don’t know the cause)
A. Approximately 5 million people in the US suffer with the syndrome
B. Also known as:
1. Colitis: colon inflammation
a. does not always include inflammation
2. Spastic colon:
a. does not always occur in the colon, just most commonly
3. not to be confused with Ulcerative Colitis
C. Characterized by:
1. pain: duration >3months (dull pain in the lower abdomen for more than 3 months)
D. Symptoms:
1. diarrhea, constipation or alternating episodes or both (spastic= fast diarrhea, slow constipation)
2. flatulence, bloating
3. indigestion, belching, heartburn, nausea
4. mucus in the stool
E. Medical Nutrition Therapy
1. acute:
a. elemental diet for persons with acute IBS (predigested)
b. Proteins in short amino acid chains (peptides...short peptides taste better than amino acids) Purpose of elemental diet is to provide nutrients in a form easy to absorb. Need to quickly absorb the nutrients before diarrhea rushes it out.
2. chronic:
a. low fat diet with liberal fruits and veggies
i. soluble fiber
b. avoid milk
i. lactose intolerance common
c. liberal lactose free liquids
d. avoid spicy foods
e. avoid gas-forming foods
f. avoid caffeine, alcohol, sorbitol (all stimulants)
i. sorbitol: sugar alcohol. Not absorbed, that’s why its used a a sweetener in diet food.
F. Client Education
1. Vit B-complex supplement may be necessary
2. Encourage regular bowel evacuation
3. Stress and coping mechanisms (frequently seen in patients who don’t deal well with psychological stress)
4. Regular exercise
5. Food diaries may help identify food sensitivities
6. Products that reduce intestinal gas (Bean-O)
II Diverticular Disease
A. Diverticula: the presence of outpouchings in the intestinal wall. (size of a pin)
1. diverticulum = 1
2. Diverticulitis: inflammation of the diverticula
3. Diverticulosis: the presence of diverticula
B. Medical Nutrition Therapy
1. Diverticulitis (inflamed state)
a. bowel rest – NPO for 1-2 days (IV only)
b. clear liquids (minimum residue and low fat)
c. progress to soft, low fat diet
d. no excess spices or fiber (to give a chance for healing)
e. Gradually progress to normal fiber intake as inflammation decreases
2. Diverticulosis (convalescent state)
a. high fiber - > 30 grams per day desirable
i. start with small amount and increase gradually because of gas
ii. add whole grains, raw fruits, and vegetables
b. increase fluid intake
c. low fat
3. in both conditions AVOID:
a. small seeds (strawberries, poppy)
b. nuts, chunky peanut butter
c. popcorn
d. corn
e. fibrous vegetables (celery, cabbage stems)
f. stress
4. Only cure is removal of that part of the intestine. Easier to manage with diet.
III Ulcerative Colitis
A. Inflammatory bowel disease: not to be confused with IBS (blood in stool)
B. Symptoms
1. diarrhea (resulting in malabsorption)
2. Rectal bleeding (resulting in anemia) (Stool will be red because blood is not absorbed. Black and tarry stools are absorbed blood from upper GI bleeding)
3. cramping, abdominal pain
4. anorexia (loss of appetite)
5. weight loss
C. Medical Nutrition Therapy
1. Dietary interventions do not lessen disease (but keep the pt more healthy so they can withstand the treatment)
2. low fiber (so not as much interaction in the lower GI, give it a rest so it can heal)
3. lactose free
4. vitamin and mineral supplementation
5. protein so they get enough calories to withstand treatment
IV Regional Enteritis (Crohn’s Disease)
A. Inflammation and ulceration of the GI tract
1. In severe cases, no digestion or absorption
2. Steatorrhea: fatty stools (foamy, smelly...saponification of fats)
B. Nutrition consequences
1. protein malnutrition
a. hypoalbuminemia (check albumin levels, low)
2. Vitamin deficiencies
a. Vit B12
b. folate
c. C
d. fat solubles ADEK
3. Mineral deficiencies
a. calcium
b. magnesium
c. zinc
d. iron
4. anemia
C. Medical Nutrition Therapy
1. high kcal, especially if losing 30%, eat 30% more
2. high protein (1-1.5g/kg...go up to 2x RDA)
3. fat restricted if steatorrhea is present
4. low fiber
5. vitamin and mineral supplementation, give liquid based when having diarrhea
6. avoid foods not well tolerated (i.e. lactose)
7. small, frequent meals recommended
V Celiac Disease
A. also known as Celiac Sprue
B. Inflammatory condition of the GI tract that affects the small intestines
C. Malabsorption due to a sensitivity to gliadin
1. gliadin: part of the protein gluten found in: wheat, buckwheat, rye, barley. Oats can usually be taken in small amounts
D. Consequences
1. protein malnutrition (low serum protein levels)
2. anemia: iron, folate, and B12 deficiency
3. steatorrhea, diarrhea (resulting in weight loss)
4. calcium deficiency (resulting in bone pain)
5. Vitamin and mineral deficiencies (fat soluble vitamins lost with steatorrhea)
E. Medical Nutrition Therapy
1. Gliadin-free/gluten restricted diet
a. no wheat, buckwheat, rye, barley
b. small amount of oats (be careful, they may have been contaminate with wheat during processing)
2. May have:
a. corn
b. rice
c. tapioca
d. potato
e. arrowroot
f. cassava (yuca)
g. gluten free flour
3. lactose restricted
4. vitamin and mineral supplementation