Diet and GI Disease

Question 1

What is eosinophilic esophagitis?

Answer 1

chronic allergic inflammatory condition with eosinophilic infiltration of the lining of the esophagus

Question 2

What are characteristics of eosinophilic esophagitis?

Answer 2

long-term damage including scarring and strictures
odynophagia or dysphagia (may result in food impaction, inability to eat, reflux)

Reflux can cause further irritation

Question 3

How is eosinophilic esophagitis treated?

Answer 3

medication
diet changes

Question 4

What dietary modifications can be made to treat eosinophilic esophagitis?

Answer 4

Removing allergy causing foods
SFED
Elemental diet

Question 5

What are the key characteristics of the six-food elimination diet?

Answer 5

diet based on removing six most common allergy-causing foods: milk, wheat, eggs, soy, peanuts/tree nuts, fish/shellfish

Question 6

what are benefits of the SFED?

Answer 6

improves disease process in a majority of patients (histologic response in 69% of patients, symptom response in 87% of patients)
no other restrictions other than allergy foods in terms of diet unless specified by provider

Question 7

What is a elemental diet?

Answer 7

Diet based on nutrient-enriched amino acid formulas

amino acids mixed with sugars, fats, minerals, and vitamins totally replace table food
usually for a short period

Question 8

what population is elemental diet used more often in?

Answer 8

children (but can be used in adults)

Question 9

what is the benefit of the elemental diet?

Answer 9

improves disease in majority of patients (95% histologic, 100% symptom)

Question 10

disease characterized by recurrent retrograde acid reflux in the esophagus

Answer 10

gastroesophageal reflux disease

Question 11

what are symptoms of GERD?

Answer 11

burning pain, often shortly after eating, difficulty swallowing, regurgitation of food

Question 12

What are complications of GERD?

Answer 12

long-term damage to esophagus

Question 13

how can GERD be treated?

Answer 13

lifestyle changes
medication
diet changes

Question 14

chronic recurring upper abdominal discomfort

Answer 14

dyspepsia (symptom not diagnosis)

Question 15

a patient can be diagnosed with _____ if dyspepsia without other symptoms

Answer 15

functional dyspepsia

Question 16

what are manifestations of dyspepsia?

Answer 16

burning pain, bloating, early satiety, gassiness, nausea

Question 17

open sores form on mucosal membrane of the stomach or duodenum

Answer 17

peptic ulcer disease

Question 18

what are causes of peptic ulcer disease?

Answer 18

NSAID use
H. pylori
gastrinomas

Question 19

how is peptic ulcer disease treated?

Answer 19

medication
surgery
diet changes

Question 20

how should macros be adjusted for patients with GERD, dyspepsia, and PUD?

Answer 20

carbs-avoidance of simple carbs and increase of fiber (mediterranean diet)
protein- nothing for or against
fats-high-fat and fried foods may trigger symptoms

Question 21

What is patient diet education for GERD, dyspepsia, PUD?

Answer 21

avoidance of trigger foods:
generally acidic foods, spicy foods, gastric irritants, others

Avoid alcohol (can increase likelihood of peptic ulcer formation)
Dairy is associated with lower risk
CAM/herbals: curcumin, ginger, peppermint oil can relieve GI symptoms

Acidic foods: tomato-based foods, citrus foods, carbonated beverages
spicy foods: capsaicin-related
gastric irritants: coffee, tea, tobacco, alcohol, peppermint
others-fried or fatty foods, large meals, chocolate

Question 22

what are lifestyle modifications for patients with GERD?

Answer 22

small, frequent meals
avoiding laying down flat after eating
elevating head of bed
quitting tobacco, alcohol, caffeine
avoiding tight clothing
weight loss of 10% or more (has most evidence to support)

Question 23

foods high in non-digestable fiber that promote the growth of beneficial gut bacteria

Answer 23

prebiotics

Question 24

food containing live commensal organisms associated with health benefits

Answer 24

probiotics

Question 25

what are common strains of probiotics?

Answer 25

lactobacillus, bifidobacterium, saccharomyces, non-pathogenic strains of E-Coli Lactobacilli often in dairy products bifidobacterium growth encouraged by fructo-oligosaccharides

Question 26

What is a negative aspect of probiotics?

Answer 26

wide variation in quality control of products, some may even have pathogenic bacteria

Question 27

symptom based disorder characterized by one or more of the following: infrequent stools, hard stools, difficult stool passage

Answer 27

constipation

Question 28

what can constipation be associated with?

Answer 28

-hemorrhoids -diverticulosis -anal fissures Many potential causes

Question 29

What is a cornerstone of constipation treatment?

Answer 29

increasing fiber intake with goal of 30 g/day

Question 30

What foods can be good for constipation?

Answer 30

-fruit and vegetable fiber with good blend of soluble and insoluble fibers -dried fruits particularly prunes (contain sorbitol), but may be associated with increased gas/bloating -bran cereals, whole grain products

Question 31

If a patient is not willing to eat naturally occuring fiber, what supplements can be used?

Answer 31

fiber additives: dextrin, methylcellulose, psyllium, calcium polycarbophil

Question 32

what are side effects of fiber additives?

Answer 32

gas, bloating, flatulence, abdominal pain

Question 33

If _____ is poor, constipation symptoms are still likely even with adequate fiber intake

Answer 33

hydration status fiber increases stool bulk by absorbing water so goal intake is 1.5-2 L of fluid per day

Question 34

what lifestyle modification/supplement can help with constipation?

Answer 34

physical activity Probiotics (not strongly backed by evidence)

Question 35

3 or more loose, watery stools per day

Answer 35

diarrhea

Question 36

what are causes of diarrhea?

Answer 36

infection, inflammation, altered neurohormonal signals, altered GI secretions

Question 37

when is diarrhea considered chronic?

Answer 37

if going on for greater than 4 weeks

Question 38

if diarrhea is acute, what is the most likely cause?

Answer 38

infection

Question 39

what are helpful dietary guidelines for diarrhea?

Answer 39

maintain hydration with electrolyte rich fluids BRAT(Y) diet Probiotics may help: often recommended prophylactically with abx

Question 40

What is the BRAT (Y) diet?

Answer 40

Bananas, rice, applesauce, toast +/- yogurt with active cultures, no added sugars, or artificial sweeteners Not for long term chronic diarrhea because is not nutritionally complete

Question 41

what are potential causes of chronic diarrhea?

Answer 41

infectious, medication-related, inflammatory, food intolerance, pancreatic disorders

Question 42

What is recommended for chronic diarrhea?

Answer 42

low-FODMAP diet

Question 43

what is low-FODMAP diet?

Answer 43

restricting fermentable oligosaccharides, disaccharides, monosaccharides, and polyols -->thought to increase gas, bloating, and abdominal pain including sugar alcohols, wheat, milk, several fruits and veggies temporary elimination diet where foods are removed and gradually re-introduced to see which foods are tolerated vs not Probiotics but weak/limited evidence