Topic 7 Upper and Lower GI and Nutritional Problems

• What is irritable bowel syndrome (IBS)?

  Lower GI tract disorder characterized by chronic abdominal pain and altered bowel patterns.
• The cause of IBS is unknown.
• Diet intolerances that can contribute to IBS include gluten and fermentable oligo, disaccharide lactose, monosaccharide fructose, and polyols.
• What are oligosaccharide examples?

  Wheat and rye products, some fruits and vegetables, onions, garlic, legumes, and nuts.
• What are disaccharide examples?

  Found in milk and milk products
• What are monosaccharide fructose examples?

  Honey, apples, pears, and high fructose corn syrup.
• What are examples of polyols?

  Found in apples, pears, stone fruits, cauliflower, mushrooms, and artificial sweeteners (sorbitol).
• What are some clinical manifestations of IBS?

  Diarrhea, constipation, or both.
• For diagnosing IBS, what does the Rome IV criteria require?

  Abdominal pain and/or discomfort for at least 1 day a week for 3 months that is associated with with 2 or more of the following: related to defecation, change in stool frequency, and change in stool form.
• What are the types of IBS that can be categorized based on stool patterns?

  IBS with constipation, IBS with diarrhea, IBS mixed, and IBS unsubtyped.
• What is GERD?

  The most common upper GI problem caused by stomach acid reflux that damages the inner lining of the esophagus.
• Nausea and vomiting are the most common signs of GI disease.
• Nausea is a feeling of discomfort in the epigastrium with a conscious desire to vomit.
• Vomiting is a forceful ejection of partially digested food and secretions (emesis) from the upper GI tract.
• Nausea is subjective.
• Vomiting can cause metabolic alkalosis due to loss of gastric hydrochloric acid.
• Metabolic acidosis occurs from vomiting small intestine contents.
• Avoid using promethazine through parenteral routes since it can cause severe tissue injury. So use oral or rectal formulations.
• Metoclopramide is a prokinetic drug.
• What drug if used chronically or with a high dose can cause tardive dyskinesia?

  Metoclopramide (Reglan)
• The main factor that causes GERD is an incompetent lower esophageal sphincter (LES).
• What is one of the purposes of the LES?

  Preventing acid reflux.
• What foods or drinks can cause decreased lower esophageal pressure?

  Alcohol, chocolate due to theobromine, drugs, fatty foods, nicotine, peppermint or spearmint, tea, coffee due to caffeine.
• What can increase lower esophageal pressure?

  Bethanechol (Urecholine) and Metoclopramide (Reglan).
• Heartburn or pyrosis is the most common symptom of GERD.
• What is dyspepsia?

  Pain or discomfort centered in the upper abdomen.
• Regurgitation is described as hot, bitter, or sour liquid coming into the throat or mouth.
• GERD patients may report wheezing, coughing, and dyspnea.
• GERD patients may also report hoarseness, sore throat, globus sensation (something in throat), hypersalivation, and choking.
• Esophagitis is a common complication of GERD.
• Chest pain due to GERD can be relieved with antacids.
• What is Barrett esophagus?

  Esophageal metaplasia changes the flat epithelial cells into columnar epithelial cells due to GERD which is a precancerous sign of esophageal cancer.
• What are risk factors for BE?

  GERD, obesity, smoking, being white, being male.
• GERD can also cause dental erosion.
• How is GERD diagnosed?

  Endoscopy of the upper GI, esophagram (barium swallow), motility (manometry) studies, pH monitoring, radionuclide studies, biopsy and cytological analysis.
• How can you manage GERD conservatively?

  Elevate the head of bed 30 degrees, avoid reflux inducing foods (chocolate, fatty foods, peppermint), avoid alcohol, reduce or avoid acidic pH foods like colas, red wine, orange juice).
• What drugs are used to manage GERD?

  Proton pump inhibitors (PPIs), H2 receptor blockers, Antacids, Prokinetics.
• PPIs taken in high doses or over long periods of time can lead to increased risk of bone fractures.
• Patients should take the lowest dose for the shortest amount of time when taking PPIs.
• There is no specific diet for GERD patients aside from avoiding foods that can decrease LES pressure but should follow a low fat diet, eat small and frequent meals, and avoid eating within 3 hours of bedtime and do not lie down 2 - 3 hours after eating.