Lecture 10: GI Diet

Question 1

What is eosinophilic esophagitis? (EoE)

Answer 1

Chronic, allergic, inflammatory condition, with eosinophilic infiltration of the lining of the esophagus.

Question 2

What characterizes EoE?

Answer 2

• Odynophagia
• Dysphagia
  Resulting food impact, inability to eat, and reflux.

Question 3

What are the long-term effects of EoE?

Answer 3

• Scarring
• Strictures

Question 4

What are the suggested dietary modifications for someone with EoE?

Answer 4

• First-line: Elimination diet of milk.
• Second-line; 4FED (four-food elimination diet)
• SFED (six-food elimination diet), more conservative.
• Elemental diet (Nutrient-rich amino acid formulas)

Question 5

What falls under a 4FED diet?

Answer 5

• Milk
• Wheat
• Eggs
• Soy

Question 6

What is a SFED? What are the six?

Answer 6

Diet based on removing the 6 most common allergy-causing foods. No other diet restrictions.
* Milk
* Wheat
* Eggs
* Soy
* Peanuts/tree nuts
* Fish/shellfish

Question 7

How efficacious is a SFED?

Answer 7

• Histologic response in 69%.
• Symptom response in 87%.

Question 8

What is an elemental diet? What makes it up?

Answer 8

Diet based on nutrient-enriched amino acid formulas.
* Totally replace table food to meet nutritional need.
* Limiting flavoring/sweeteners
* 2-6 weeks only (SHORT PERIOD)
* They just eat amino acids mixed with sugars, fats, minerals, and vitamins.

Question 9

Who usually does an elemental diet?

Answer 9

Children with EoE most commonly.

Question 10

How efficacious is an elemental diet?

Answer 10

• Histologic response in 95%.
• Symptom response in 100%.

Question 11

What is GERD?

Answer 11

Gastroesophageal Reflux Disease, characterized by recurrent retrograde acid reflux in the esophagus.

Question 12

How is GERD typically described? What is the main concern with long-term GERD?

Answer 12

• Burning pain, shortly after eating
• Dysphagia
• Regurgitation of food.

Long-term damage to the esophagus

Question 13

How do we treat GERD?

Answer 13

• Lifestyle changes
• Medications
• Diet changes

Question 14

What is dyspepsia?

Answer 14

Chronic, recurring, upper abdominal discomfort. (symptom)

Question 15

How is dyspepsia commonly described?

Answer 15

• Burning pain
• Bloating
• Early satiety
• Gassiness
• Nausea

Question 16

What is peptic ulcer disease?

Answer 16

Open sore/ulcers that form on the mucosal membrane of the stomach for duodenum.

Question 17

What are the MCC of PUD?

Answer 17

• NSAID use
• H. pylori
• Gastrinomas

Question 18

How do we treat PUD?

Answer 18

• Medication
• Surgery
• Diet changes

Question 19

What diet changes are recommended for GERD, dyspepsia, and PUD?

Answer 19

• Carbs: Avoid simple carbs and increase fiber (medi diet)
• Protein: no change
• Fats: High-fat foods and fried foods may trigger symptoms.

Question 20

What should people with GERD, dyspepsia, and PUD avoid?

Answer 20

• Acidic foods (tomato-based, citrus, carbonated)
• Spicy (Capsaicin)
• Gastric irritants (Coffee, tea, tobacco, alcohol, peppermint)
• Others: fried/fatty foods, large meals, chocolate.
• Alcohol
• Dairy (fermented dairy = lower PUD risk)
• CAM/herbals (mixed evidence)

Question 21

What are some simple lifestyle modifications can help with GERD?

Answer 21

• Small, frequent meals
• Avoiding laying flat after eating
• Elevating the head of the bed
• Avoid tobacco, alcohol, caffeine
• Avoid tight clothing
• Weight loss of 10% or more!

Question 22

What are prebiotics?

Answer 22

Foods high in non-digestible fiber that promote the growth of healthy bacteria.

Question 23

What are probiotics?

Answer 23

Food containing live commensal organisms associated with health benefits.

Question 24

What are the commensal bacteria/yeast in probiotics?

Answer 24

• Lactobacillus
• Bifidobacterium
• Saccharomyces
• Non-pathogenic E. coli

Question 25

What food usually has lactobaccilus?

Answer 25

Fermented dairy products.

Question 26

What food usually has bifidobacterium?

Answer 26

Fructo-oligosaccharides (prebiotics)

Question 27

What characterizes constipation?

Answer 27

1+ of the following. * Infrequent stools * Hard stools * Difficult stool passage

Question 28

What are the complications associated with constipation?

Answer 28

* Hemorrhoids * Diverticulosis * Anal Fissures

Question 29

What is the cornerstone treatment for constipation?

Answer 29

30g/day of fiber, with an emphasis on fruit and veggie fiber.

Question 30

What kind of fruit has a lot of fiber and sorbitol?

Answer 30

Dried fruits in general, but prunes specifically have sorbitol, which may cause increased gas and bloating! | Helps to pass stool easier but can have SE.

Question 31

What are the fiber additives?

Answer 31

* Dextrin * Methylcellulose * Psyllium * Calcium polycarbophil * Often has associated SE of gas, bloating, flatulence, abd pain. | Often used for children who refuse to eat fiber.

Question 32

What must be taken alongside fiber to ensure it works?

Answer 32

* Water hydration. * Fiber specifically absorbs water into the GI lumen to increase stool bulk. * You need 1.5-2L of water a day.

Question 33

Are probiotics recommended for constipation?

Answer 33

NO

Question 34

What is diarrhea? Chronic?

Answer 34

3+ loose OR watery stools a day. Chronic is 4+ weeks.

Question 35

What is the most common underlying etiology in acute diarrhea?

Answer 35

Infectious

Question 36

How should we manage acute diarrhea?

Answer 36

* Electrolyte-rich fluids * BRAT(Y) diet * Probiotics may help

Question 37

What is the BRAT(y) diet?

Answer 37

* Bananas * Rice * Applesauce * Toast * Yogurt (sometimes) | Yogurt must have active cultures, no additive sweetners.

Question 38

How should we manage chronic diarrhea?

Answer 38

Trial a low-FODMAP diet.

Question 39

What is a low-FODMAP diet?

Answer 39

* Fermentable Oligosaccharides * Disaccharides * Monosaccharides * And Polyols. You then slowly reintroduce these one by one to see which ones are tolerable. | Avoid artificial sweeteners long-term.