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measures\tto\tbe\taccomplished\tin\tthe\tsmall\tbowel\tvia\tcapsule\tendoscopy.\nThe\tincidence\tand\tnumber\tof\tsurgical\tprocedures\trelated\tto\tpeptic\tulcers\thas\tdecreased\tmarkedly\nin\tthe\tpast\t3\tdecades\tbecause\tof\trecognition\tof\tsymptoms\tand\trisk\tfactors,\tand\tearlier\tscreening\tfor\nH.\tpylori
|
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H.\tpylori\n.\tUncomplicated\tpeptic\tulcers\tin\teither\tthe\tgastric\tor\tduodenal\tregion\tmay\tpresent\twith\nsigns\tsimilar\tto\tthose\tassociated\twith\tdyspepsia\tand\tgastritis.\nAbdominal\tdiscomfort\tis\tthe\tmost\tcommon\tsymptom\tof\tpeptic\tulcers\tand\tcan\tbe\tfelt\tanywhere
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between\tthe\tnavel\tand\tthe\tbreastbone.\tThis\tdiscomfort\tis\tusually\tdescribed\tas\ta\tdull\tor\tburning\tpain\nthat\toccurs\twhen\tthe\tstomach\tis\tempty\t(between\tmeals\tor\tduring\tthe\tnight),\tand\tmay\tbe\tbriefly\nrelieved\tby\teating\tfood,\tin\tthe\tcase\tof\tduodenal\n\tulcers,\tor\tby\ttaking\tantacids.\tIn\tboth\ttypes\tof\tpeptic
|
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] |
ulcers,\tor\tby\ttaking\tantacids.\tIn\tboth\ttypes\tof\tpeptic\nulcers,\tthe\tsymptoms\tlast\tfor\tminutes\tto\thours\tand\tcome\tand\tgo\tfor\tseveral\tdays\tor\tweeks.\tOther\nsymptoms\tinclude\tbloating,\tburping,\tnausea,\tvomiting,\tpoor\tappetite,\tand\tweight\tloss.\tSome\tpeople\nexperience\tonly\tmild\tsymptoms\tor\tnone\tat\tall.
|
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experience\tonly\tmild\tsymptoms\tor\tnone\tat\tall.\nPeptic\tulcers\talso\tmay\thave\t“emergency\tsymptoms,”\tin\twhich\tmedical\tassistance\tshould\tbe\tsought\nimmediately.\n\tThese\tinclude\tsharp,\tsudden,\tpersistent,\tand\tsevere\tstomach\tpain,\tbloody\tor\tblack\nstools\t(\nmelena\n),\tbloody\tvomit\t(hematemesis),\tor\tvomit\tthat\tlooks\tlike\tcoffee\tgrounds.\tThese
|
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] |
symptoms\tcould\tbe\tsigns\tof\ta\tserious\tproblem,\tsuch\tas:\n•\t\nAcute\tor\tchronic\tGI\tbleed:\twhen\tacid\tor\ta\tpeptic\tulcer\tbreaks\ta\tblood\tvessel.\n•\t\nGI\tperforation:\twhen\ta\tpeptic\tulcer\tburrows\tcompletely\tthrough\tthe\tstomach\tor\tduodenal\nwall,\tpotentially\tpenetrating\tan\tadjacent\torgan\t(e.g.,\tpancreas)\n•
|
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wall,\tpotentially\tpenetrating\tan\tadjacent\torgan\t(e.g.,\tpancreas)\n•\t\nGI\tobstruction:\twhen\ta\tpeptic\tulcer\tblocks\tthe\tpath\tof\tfood\ttrying\tto\tleave\tthe\tstomach.
|
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] |
If\tor\twhen\tthese\tproblems\toccur,\timmediate\tmedical\tattention\tis\tnecessary,\tas\tcomplications\tof\nhemorrhage\tand\tperforation\tcontribute\tsignificantly\tto\tthe\tmorbidity\tand\tmortality\tof\tpeptic\tulcers.\nGastric\tversus\tduodenal\tulcers\nPathophysiology\nAlthough\tgastric\tulcers\tcan\toccur\tanywhere\tin\tthe\tstomach,\tmost\toccur\talong\tthe\tlesser\tcurvature\n(
|
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0.07887370139360428,
-0.06817159056663513
] |
(\nFig.\t26.5\n).\t\nGastric\tulcers\n\ttypically\tare\tassociated\n\twith\twidespread\tgastritis,\tinflammatory\ninvolvement\tof\tparietal\tcells,\tand\tatrophy\tof\tacid-\tand\tpepsin-producing\tcells\toccurring\twith\nadvancing\tage.\tIn\tsome\tcases,\tgastric\tulceration\tdevelops\tdespite\trelatively\tlow\tacid\toutput.\tAntral
|
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] |
hypomotility,\tgastric\tstasis,\tand\tincreased\tduodenal\treflux\tare\tassociated\tcommonly\twith\tgastric\nulcers,\tand\twhen\tpresent,\tmay\tincrease\tthe\tseverity\tof\tthe\tgastric\n\tinjury.\tThe\tincidence\tof\nhemorrhage\tand\toverall\tmortality\tis\thigher\twith\ta\tgastric\tulcer\tthan\ta\tduodenal\tulcer.
|
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] |
FIG.\t26.5\nA,\n\tDiagram\tshowing\ta\tnormal\tstomach\tand\tduodenum;\t\nB,\n\ta\tgastric\tulcer;\t\nC,\n\ta\tduodenal\tulcer.\nA\t\nduodenal\tulcer\n\tis\tcharacterized\tby\tincreased\tacid\tsecretion\tthroughout\tthe\tentire\tday\naccompanied\twith\tdecreased\tbicarbonate\tsecretion.\tMost\tduodenal\tulcers\toccur\twithin\tthe\tfirst\tfew
|
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] |
centimeters\tof\tthe\tduodenal\tbulb,\tin\tan\tarea\timmediately\tbelow\tthe\tpylorus.\tGastric\toutlet\nobstruction\toccurs\n\tmore\tcommonly\twith\tduodenal\tulcers\tthan\twith\tgastric\tulcers,\tand\tgastric\nmetaplasia\t(e.g.,\treplacement\tof\tduodenal\tvillous\tcells\twith\tgastric-type\tmucosal\tcells)\tmay\toccur\nwith\tduodenal\tulcer\trelated\tto\t\nH.\tpylori\n.
|
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with\tduodenal\tulcer\trelated\tto\t\nH.\tpylori\n.\nMedical\tand\tsurgical\tmanagement\tof\tulcers\nRegardless\tof\tthe\ttype\tof\tulcer,\tthe\tfirst\tintervention\tis\tto\tevaluate\tthe\tpatient\tendoscopically\tand\nresuscitate\tas\tneeded.\tControl\tacute\n\tbleeding\tif\tpresent.\nPeptic\tulcers.\nH.\tpylori
|
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bleeding\tif\tpresent.\nPeptic\tulcers.\nH.\tpylori\n\tis\tthe\tprimary\tcause\tof\tgastritis\tand\tpeptic\tulcers,\tthus\tits\tdiagnosis\tif\tpresent,\tand\ntreatment,\tshould\tbe\tthe\tfirst\tmedical\tintervention.\tAt\tthe\tfirst\tendoscopy,\tdiagnostic\tbiopsies\tshould\nbe\ttaken\tfor\t\nH.\tpylori\n.\tTreatment\tof\t\nH.\tpylori\n\tinfection\tentails\teradication\tof\tthis\torganism\twith\tthe
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H.\tpylori\n\tinfection\tentails\teradication\tof\tthis\torganism\twith\tthe\nappropriate\tantibiotic\tand\tacid-suppressive\tregimen.\n\tAlthough\tsurgical\tintervention\tis\tless\nprevalent,\temergent\tand\telective\tprocedures\tand\tsurgeries\tare\tstill\trequired\tfor\tpeptic\tulcer
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] |
complications.\tInterventions\tcan\trange\tfrom\tendoscopic,\topen,\tand\tlaparoscopic\tprocedures\tto\ttreat\nindividual\tlesions,\tto\tpartial\tgastrectomy\tand\toccasionally\tselective\tvagotomies.\nStress\tulcers.\nStress\tulcers\n\tmay\toccur\tas\ta\tcomplication\tof\tmetabolic\tstress\tcaused\n\tby\ttrauma,\tburns,\tsurgery,
|
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0.03952417150139809,
0.06786401569843292,
0.014696620404720306,
0.04601108282804489,
0.0557083785533905,
0.000019683957361849025
] |
by\ttrauma,\tburns,\tsurgery,\nshock,\trenal\tfailure,\tor\tradiation\ttherapy.\tA\tprimary\tconcern\twith\tstress\tulceration\tis\tthe\tpotential\nfor\tsignificant\tGI\themorrhage.\tGastric\tischemia\tassociated\twith\tGI\thypoperfusion,\toxidative\tinjury,\nreflux\tof\tbile\tsalts\tand\tpancreatic\tenzymes,\tmicrobial\tcolonization,\tand\tmucosal\tbarrier\tchanges\talso
|
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] |
have\tbeen\timplicated.\tAlthough\tstress\tulcerations\tusually\toccur\n\tin\tthe\tfundus\tand\tbody\tof\tthe\nstomach,\tthey\talso\tmay\tdevelop\tin\tthe\tantrum,\tduodenum,\tor\tdistal\tesophagus.\tTypically\tshallow,\nand\tcausing\toozing\tof\tblood\tfrom\tsuperficial\tcapillary\tbeds,\tstress\tulcer\tlesions\talso\tmay\toccur
|
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] |
deeper,\teroding\tinto\tthe\tsubmucosa,\tcausing\tmassive\themorrhage\tor\tperforation.\nStress\tulcers\tthat\tbleed\tcan\tbe\ta\tsignificant\tcause\tof\tmorbidity\tin\tthe\tcritically\till\tpatient\n\t(see\nChapter\t37\n).\tAlthough\tcurrent\tprevention\tand\ttreatment\tinclude\tsucralfate,\tacid\tsuppressants,\tand
|
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] |
antibiotics\tas\tneeded,\thigh-quality\tevidence\tto\tguide\tclinical\tpractice\tin\teffective\ttreatments\tis\nlimited.\tEfforts\tto\tprevent\tgastric\tulcers\tin\tstressed\tpatients\thave\tfocused\ton\tpreventing\tor\tlimiting\nconditions\tleading\tto\thypotension\tand\tischemia\tand\tcoagulopathies.\tAvoiding\tNSAIDs\tand\tlarge\ndoses\tof\tcorticosteroids\tis\talso\tbeneficial.
|
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2\n-receptor\nantagonist\tfor\tstress\tulcer\tprevention\tfound\tthis\ttherapy\tto\tbe\tpreventative\tonly\tin\tpatients\twho\tdid\nnot\treceive\tenteral\tfeeding.\tIn\tfact,\tfor\tpatients\n\treceiving\tenteral\tfeeding,\tH\n2\n-receptor\tantagonist\ntherapy\tmay\tincrease\tthe\trisk\tof\tpneumonia\tand\tdeath\t(\nChanpura\tand\tYende,\t2012\n).\tFurther
|
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] |
Chanpura\tand\tYende,\t2012\n).\tFurther\nresearch\tis\tneeded\tto\tprospectively\ttest\tthe\teffect\tof\tenteral\tfeeding\ton\tthe\trisk\tof\tstress\tulcer
|
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] |
prophylaxis.\nMedical\tnutrition\ttherapy\nIn\tpersons\twith\tatrophic\tgastritis,\tvitamin\tB\n12\n\tstatus\tshould\tbe\tevaluated\tbecause\tlack\tof\tintrinsic\nfactor\tand\tgastric\n\tacid\tresults\tin\tmalabsorption\tof\tthis\tvitamin\t(see\t\nChapter\t31\n).\tLow\tacid\tstates\tmay\ninfluence\tabsorption\tof\tiron,\tcalcium,\tand\tother\tnutrients\tbecause\tgastric\tacid\tenhances
|
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0.02118457853794098,
-0.007600739598274231,
0.057548075914382935,
0.09269513934850693,
0.108950674533844,
0.02957351878285408
] |
bioavailability.\tIn\tthe\tcase\tof\trefractory\tiron\tdeficiency\tanemia,\tother\tcauses\tmay\tbe\tthe\tpresence\tof\nH.\tpylori\n\tand\tgastritis.\tEradication\tof\t\nH.\tpylori\n\thas\tresulted\tin\timproved\tabsorption\tof\tiron\tand\nincreased\tferritin\tlevels\n\t(\nHershko\tand\tCamaschella,\t2014\n).
|
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0.009305245243012905
] |
increased\tferritin\tlevels\n\t(\nHershko\tand\tCamaschella,\t2014\n).\nFor\tseveral\tdecades\tdietary\tfactors\thave\tgained\tor\tlost\tfavor\tas\ta\tsignificant\tcomponent\tin\tthe\ncause\tand\ttreatment\tof\tdyspepsia,\tgastritis,\tand\tpeptic\tulcer\tdisease.\tThere\tis\tlittle\tevidence\tthat
|
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] |
specific\tdietary\tfactors\tcause\tor\texacerbate\tgastritis\tor\tpeptic\tulcer\tdisease.\tProtein\tfoods\ntemporarily\tbuffer\tgastric\tsecretions,\tbut\tthey\talso\tstimulate\tsecretion\n\tof\tgastrin,\tacid,\tand\tpepsin.\nMilk\tor\tcream,\twhich\tin\tthe\tearly\tdays\tof\tpeptic\tulcer\tmanagement\twas\tconsidered\timportant\tin\ncoating\tthe\tstomach,\tis\tno\tlonger\tconsidered\tmedicinal.
|
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] |
coating\tthe\tstomach,\tis\tno\tlonger\tconsidered\tmedicinal.\nThe\tpH\tof\ta\tfood\thas\tlittle\ttherapeutic\timportance,\texcept\tfor\tpatients\twith\texisting\tlesions\tof\tthe\nmouth\tor\tthe\tesophagus.\tMost\tfoods\tare\tconsiderably\tless\tacidic\tthan\tthe\tnormal\tgastric\tpH\tof\t1\tto\n3.\tThe\tpH\tof\torange
|
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] |
3.\tThe\tpH\tof\torange\n\tjuice\tand\tgrapefruit\tis\t3.2\tto\t3.6,\tand\tthe\tpH\tof\tcommonly\tused\tsoft\tdrinks\nranges\tfrom\tapproximately\t2.8\tto\t3.5.\tOn\tthe\tbasis\tof\ttheir\tintrinsic\tacidity\tand\tthe\tamount\nconsumed,\tfruit\tjuices\tand\tsoft\tdrinks\tare\tnot\tlikely\tto\tcause\tpeptic\tulcers\tor\tappreciably\tinterfere
|
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] |
with\thealing.\tSome\tpatients\texpress\tdiscomfort\twith\tingestion\tof\tacidic\tfoods,\tbut\tthe\tresponse\tis\tnot\nconsistent\tamong\tpatients,\n\tand\tin\tsome,\tsymptoms\tmay\tbe\trelated\tto\theartburn.\tThe\tdietary\ninclusion\tof\t“acidic\tfoods”\tshould\tbe\tindividualized\tbased\ton\tthe\tpatient’s\tperception\tof\ttheir\teffect.
|
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] |
Consumption\tof\tlarge\tamounts\tof\talcohol\tmay\tcause\tat\tleast\tsuperficial\tmucosal\tdamage\tand\tmay\nworsen\texisting\tdisease\tor\tinterfere\twith\ttreatment\tof\tthe\tpeptic\tulcer.\tModest\tconsumption\tof\nalcohol\tdoes\tnot\tappear\tto\tbe\tpathogenic\n\tfor\tpeptic\tulcers\tunless\tcoexisting\trisk\tfactors\tare\talso
|
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for\tpeptic\tulcers\tunless\tcoexisting\trisk\tfactors\tare\talso\npresent.\tOn\tthe\tother\thand,\tbeers\tand\twines\tsignificantly\tincrease\tgastric\tsecretions\tand\tshould\tbe\navoided\tin\tsymptomatic\tdisease.\nCoffee\tand\tcaffeine\tstimulate\tacid\tsecretion\tand\talso\tmay\tdecrease\tLES\tpressure;\thowever,\tneither
|
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has\tbeen\tstrongly\timplicated\tas\ta\tcause\tof\tpeptic\tulcers\toutside\tof\tthe\tincreased\tacid\tsecretion\tand\ndiscomfort\n\tassociated\twith\ttheir\tconsumption.\nWhen\tvery\tlarge\tdoses\tof\tcertain\tspices\tare\tfed\torally\tor\tplaced\tintragastrically\twithout\tother\nfoods,\tthey\tincrease\tacid\tsecretion\tand\tcause\tsmall,\ttransient\tsuperficial\terosions,\tinflammation\tof
|
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the\tmucosal\tlining,\tand\taltered\tGI\tpermeability\tor\tmotility.\tSmall\tamounts\tof\tchili\tpepper\tor\tits\nactive\tcomponent,\tcapsaicin,\tmay\tincrease\tmucosal\tprotection\tby\tincreasing\n\tproduction\tof\tmucus.\nThe\tburning\tsensation\tin\tthe\tgut\twhen\tcapsaicin\tis\tconsumed\tis\tdue\tto\ttransient\treceptor\tpotential
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] |
vanilloid-1\t(TRPV1)\treceptors\tthroughout\tthe\tGI\ttract,\tand\trepeated\texposure\tcan\tdesensitize\tthe\nreceptor.\tLarger\tamounts\tof\tcapsaicin\tmay\tnot\tbe\tas\twell\ttolerated\tand\tcould\tcause\tsuperficial\nmucosal\tdamage,\tespecially\twhen\tconsumed\twith\talcohol,\tas\tTRPV1\treceptors\tcan\n\talso\tbe\tstimulated\nby\tethanol\t(\nPatcharatrakul\tand\tGonlachanvit,\t2016
|
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] |
by\tethanol\t(\nPatcharatrakul\tand\tGonlachanvit,\t2016\n).\tAnother\tspice,\tcurcumin,\tthrough\tits\nantiinflammatory\tactivity\tthat\tinhibits\tthe\tNF-κB\tpathway\tactivation\tmay\tbe\ta\tchemopreventive\ncandidate\tagainst\t\nH.\tpylori\n–related\tcancer\t(\nSarkar\tet\tal,\t2016\n)\t(see\t\nChapter\t12\n).
|
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] |
H.\tpylori\n–related\tcancer\t(\nSarkar\tet\tal,\t2016\n)\t(see\t\nChapter\t12\n).\nOverall,\ta\thigh-quality\tdiet\twithout\tnutrient\tdeficiencies\tmay\toffer\tsome\tprotection\tand\tmay\npromote\thealing.\tPersons\n\tbeing\ttreated\tfor\tgastritis\tand\tpeptic\tulcer\tdisease\tshould\tbe\tadvised\tto
|
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avoid\tfoods\tthat\texacerbate\ttheir\tsymptoms\tand\tto\tconsume\ta\tnutritionally\tcomplete\tdiet\twith\nadequate\tdietary\tfiber\tfrom\tfruits\tand\tvegetables.\nCarcinoma\tof\tthe\tstomach\nAlthough\tthe\tincidence\tand\tmortality\thave\tfallen\tdramatically\tover\tthe\tlast\t50\tyears\tin\tmany\tregions,\ngastric\tcancer\tis\tstill\tthe\tsecond\tmost\tcommon
|
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gastric\tcancer\tis\tstill\tthe\tsecond\tmost\tcommon\n\tcause\tof\tcancer\tdeath\tworldwide,\twith\tvarying\nincidence\tin\tdifferent\tparts\tof\tthe\tworld\tand\tamong\tvarious\tethnic\tgroups\t(\nNagini,\t2012\n).\tDespite\nadvances\tin\tdiagnosis\tand\ttreatment,\tthe\t5-year\tsurvival\trate\tof\tstomach\tcancer\tis\tonly\t20%.\nEtiology
|
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] |
Etiology\nThe\tcause\tof\tgastric\tcancer\tis\tmultifactorial,\tbut\tmore\tthan\t80%\tof\tcases\thave\tbeen\tattributed\tto\t\nH.\npylori\n\tinfection.\tIn\taddition,\tdiet,\tlifestyle,\n\tgenetic,\tsocioeconomic,\tand\tother\tfactors\tcontribute\tto\ngastric\tcarcinogenesis.\tA\tWestern\tdiet,\thigh\tin\tprocessed\tmeats,\tfat,\tstarches,\tand\tsimple\tsugars,\tis
|
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associated\twith\tan\tincreased\trisk\tof\tgastric\tcancer\tcompared\twith\ta\tdiet\thigh\tin\tfruits\tand\nvegetables\t(\nBertuccio\tet\tal,\t2013\n).\tOther\tfactors\tthat\tmay\tincrease\tthe\trisk\tof\tgastric\tcancer\tinclude\nalcohol\tconsumption,\texcess\tbody\tweight,\tsmoking,\n\tintake\tof\thighly\tsalted\tor\tpickled\tfoods,\tor
|
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] |
carcinogenic\tN-nitroso\tcompounds.\tPolycyclic\taromatic\n\thydrocarbons\tsuch\tas\tbenzo[a]pyrene\nformed\tin\tsmoked\tfood\thave\tbeen\tincriminated\tin\tmany\tareas\tof\tthe\tworld\t(\nNagini,\t2012\n).\nPathophysiology\nStomach\tcancer\trefers\tto\tany\tmalignant\tneoplasm\tthat\tarises\tfrom\tthe\tregion\textending\tbetween\tthe
|
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gastroesophageal\tjunction\tand\tthe\tpylorus.\tBecause\tsymptoms\tare\tslow\tto\tmanifest\tthemselves\tand\nthe\tgrowth\tof\tthe\ttumor\tis\trapid,\tcarcinoma\tof\tthe\tstomach\n\tfrequently\tis\toverlooked\tuntil\tit\tis\ttoo\nlate\tfor\ta\tcure.\tLoss\tof\tappetite,\tstrength,\tand\tweight\tfrequently\tprecede\tother\tsymptoms.\tIn\tsome\ncases,\t\nachylia\tgastrica
|
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cases,\t\nachylia\tgastrica\n\t(absence\tof\tHCl\tand\tpepsin)\tor\t\nachlorhydria\n\t(absence\tof\tHCl\tin\tgastric\nsecretions)\tmay\texist\tfor\tyears\tbefore\tthe\tonset\tof\tgastric\tcarcinoma.\tMalignant\tgastric\tneoplasms\ncan\tlead\tto\tmalnutrition\tas\ta\tresult\tof\texcessive\tblood\tand\tprotein\n\tlosses\tor,\tmore\tcommonly,
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] |
because\tof\tobstruction\tand\tmechanical\tinterference\twith\tfood\tintake.\nMedical\tand\tsurgical\tmanagement\nMost\tcancers\tof\tthe\tstomach\tare\ttreated\tby\tsurgical\tresection;\tthus,\tpart\tof\tthe\tnutritional\nconsiderations\tincludes\tpartial\tor\ttotal\t\ngastrectomy\n,\ta\tresection\tor\tremoval\tof\tthe\tstomach.\tSome
|
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] |
gastrectomy\n,\ta\tresection\tor\tremoval\tof\tthe\tstomach.\tSome\npatients\tmay\texperience\tdifficulties\twith\tnutrition\tafter\tsurgery.\nMedical\n\tnutrition\ttherapy\nThe\tdietary\tregimen\tfor\tcarcinoma\tof\tthe\tstomach\tis\tdetermined\tby\tthe\tlocation\tof\tthe\tcancer,\tthe\nnature\tof\tthe\tfunctional\tdisturbance,\tand\tthe\tstage\tof\tthe\tdisease.\tThe\tpatient\twith\tadvanced,
|
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] |
inoperable\tcancer\tshould\treceive\ta\tdiet\tthat\tis\tadjusted\taccording\tto\ttolerance,\tpreference,\tand\ncomfort.\tAnorexia\tis\talmost\talways\tpresent\tfrom\tthe\tearly\tstages\tof\tdisease.\tIn\tthe\tlater\n\tstages\tof\tthe\ndisease,\tthe\tpatient\tmay\ttolerate\tonly\ta\tliquid\tdiet.\tIf\ta\tpatient\tis\tunable\tto\ttolerate\toral\tfeeding,
|
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0.08290504664182663,
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0.08796028047800064,
0.10967177897691727,
0.08336643874645233,
0.001951896701939404
] |
consideration\tshould\tbe\tgiven\tto\tusing\tan\talternate\troute,\tsuch\tas\ta\tgastric\tor\tintestinal\tenteral\ttube\nfeeding,\tor\tif\tthis\tis\tnot\ttolerated\tor\tfeasible,\tparenteral\tfeeding.\tThe\tnutritional\tsupport\tfor\tthe\npatient\tshould\tbe\tin\taccordance\twith\tthe\tpatient’s\tgoals\tof\tcare\t(see\t\nChapter\t12\n).\nGastric\tsurgeries
|
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] |
Chapter\t12\n).\nGastric\tsurgeries\nBecause\tof\tincreased\trecognition\tand\ttreatment\tfor\t\nH.\tpylori\n\tand\tacid\tsecretion,\tgastric\tsurgeries\nare\tperformed\tless\tfrequently.\tHowever,\tpartial\tor\ttotal\tgastrectomy\tmay\tstill\tbe\tnecessary\tfor\npatients\twith\tulcer\tdisease\tthat\tdoes\tnot\trespond\tto\ttherapy,\tor\tfor\tthose\twith\tmalignancy.\tGastric
|
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0.04041358083486557,
-0.028978485614061356
] |
surgeries\tperformed\tfor\tweight\tloss\tor\tbariatric\tsurgeries\tare\tmore\tcommon.\n\tThese\tsurgeries,\tsuch\nas\tRoux-en-Y\tgastric\tbypass,\tgastric\tbanding,\tsleeve\tgastrectomy,\tvertical\tbanding\tgastroplasty,\tand\njejunoileal\tbypass\tare\tdesigned\tto\tinduce\tweight\tloss\tthough\tvolume\trestriction,\tmalabsorption,\tor\nboth\t(see\t\nChapter\t20\n).\nTypes\tof\tsurgeries
|
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] |
both\t(see\t\nChapter\t20\n).\nTypes\tof\tsurgeries\nA\ttotal\tgastrectomy\tinvolves\tremoval\tof\tthe\tentire\tstomach,\twhereas\tonly\ta\tportion\tof\tthe\tstomach\tis\nremoved\twith\ta\tsubtotal\tor\n\tpartial\tgastrectomy.\tA\tgastrectomy\tis\taccompanied\tby\ta\treconstructive\nprocedure.\tA\ttotal\tgastrectomy\tis\tperformed\tfor\tmalignancies\tthat\taffect\tthe\tmiddle\tor\tupper
|
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] |
stomach.\tThe\ttotal\tstomach\tis\tremoved,\tand\ta\tRoux-en-Y\treconstruction\tis\tperformed\tto\tmaintain\tGI\ntract\tcontinuity.\tWith\ta\t\nRoux-en-Y\n,\tthe\tjejunum\tis\tpulled\tup\tand\tanastomosed\tto\tthe\tesophagus.\tThe\nduodenum\tis\tthen\tconnected\tto\tthe\tsmall\n\tbowel\tso\tthat\tbile\tand\tpancreatic\tsecretions\tcan\tflow\tinto\nthe\tintestine.\t\nBillroth\tI\t(gastroduodenostomy)
|
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] |
the\tintestine.\t\nBillroth\tI\t(gastroduodenostomy)\n\tinvolves\tremoval\tof\tthe\tpylorus\tand/or\tantrum,\tand\nan\tanastomosis\tof\tthe\tproximal\tend\tof\tthe\tduodenum\tto\tthe\tdistal\tend\tof\tthe\tremnant\tstomach.\tA\nBillroth\tII\t(gastrojejunostomy)\n\tinvolves\tremoval\tof\tthe\tstomach\tantrum\tand\tan\tanastomosis\tof\tthe\nremnant\tstomach\tto\tthe\tside\tof\tthe\tjejunum,\twhich
|
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] |
remnant\tstomach\tto\tthe\tside\tof\tthe\tjejunum,\twhich\n\tcreates\ta\tblind\tduodenal\tloop\t(\nFig.\t26.6\n).\nFIG.\t26.6\nGastric\tsurgical\tprocedures\t[Billroth\tI\t(A:\tpreoperative\tand\tB:\tpostoperative),\tBillroth\tII,\tRoux\ten\tY,\npylorplasty,\tvagotomy].\nThe\t\nvagus\tnerve\n\tis\tresponsible\tfor\tnot\tonly\tmotility,\tbut\talso\tstimulation\tof\tparietal\tcells\tin\tthe
|
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] |
proximal\tstomach,\ttherefore\ta\t\nvagotomy\n\toften\tis\tperformed\tto\teliminate\tgastric\tacid\tsecretion.\nTruncal\tvagotomy\n,\tcomplete\tsevering\tof\tthe\tvagus\tnerve\ton\n\tthe\tdistal\tesophagus,\tdecreases\tacid\nsecretion\tby\tparietal\tcells\tin\tthe\tstomach\tand\tdecreases\ttheir\tresponse\tto\tthe\thormone\tgastrin.\tA\nparietal\tcell\tvagotomy
|
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parietal\tcell\tvagotomy\n\t(partial\tor\tselective)\tdivides\tand\tsevers\tonly\tthe\tvagus\tnerve\tbranches\tthat\naffect\tthe\tproximal\tstomach\twhere\tgastric\tacid\tsecretion\toccurs,\twhereas\tthe\tantrum\tand\tpylorus\nremain\tinnervated.\tVagotomy\tat\tcertain\tlevels\tcan\talter\tthe\tnormal\n\tphysiologic\tfunction\tof\tthe
|
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] |
physiologic\tfunction\tof\tthe\nstomach,\tsmall\tintestine,\tpancreas,\tand\tbiliary\tsystem.\tVagotomy\tprocedures\tcommonly\tare\naccompanied\tby\ta\tdrainage\tprocedure\t(antrectomy\tor\t\npyloroplasty\n)\tthat\taids\twith\tgastric\temptying.\nPostoperative\tmedical\tnutrition\ttherapy
|
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] |
Oral\tintake\tof\tfluids\tand\tfoods\tis\tinitiated\tas\tsoon\tas\tGI\ttract\tfunction\treturns\t(typically\t24\tto\t72\nhours\tpostoperatively).\tSmall\tfrequent\n\tfeedings\tof\tice\tor\twater\tare\tnormally\tinitiated,\tfollowed\tby\nliquids\tand\teasily\tdigested\tsolid\tfoods,\tafter\twhich\tthe\tpatient\tcan\tprogress\tto\ta\tregular\tdiet.
|
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] |
Although\tthis\tis\tthe\tcommon\tpostoperative\tdiet\tintervention,\tthere\tis\tlimited\tevidence\tsupporting\nthis\tpractice.\tIn\tfact,\tsome\tstudies\tsuggest\tbeginning\ta\tregular\tdiet\tof\ttolerated\tfoods\tas\tthe\tfirst\ndiet\tto\timprove\tpatient\ttolerance\t(\nWarren\tet\tal,\t2011\n).\tIf\tthe\tpatient\tis\tunable\tto\ttolerate\tan\toral\tdiet
|
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).\tIf\tthe\tpatient\tis\tunable\tto\ttolerate\tan\toral\tdiet\nfor\tan\textended\tperiod\tof\ttime\t(e.g.,\t5\tto\t7\tdays),\tthen\tenteral\tfeeding\tshould\tbe\tconsidered\tif\nappropriate\tfeeding\taccess\tis\tavailable,\tand\tif\tnot,\tPN\tshould\tbe\tconsidered.\nUnderstanding\tthe\tsurgery\tperformed\tand\tthe\tpatient’s\tresulting\tanatomy\tis\tparamount\tto
|
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] |
providing\tproper\tnutritional\tcare.\tNutritional\tcomplications\tafter\tgastric\tsurgeries\n\tare\tvaried\t(\nTable\n26.4\n).\tComplications\tsuch\tas\tobstruction,\tdumping,\tabdominal\tdiscomfort,\tdiarrhea,\tand\tweight\tloss\nmay\toccur,\tdepending\ton\tthe\tnature\tand\textent\tof\tthe\tdisease\tand\tsurgical\tinterventions\t(see\t\nFig.\n26.6
|
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] |
Fig.\n26.6\n).\tPatients\tmay\thave\tdifficulty\tregaining\tnormal\tpreoperative\tweight\tbecause\tof\tinadequate\tfood\nintake\trelated\tto\t(1)\tearly\tsatiety,\t(2)\tsymptoms\tof\tdumping\tsyndrome\t(see\tlater\n\tin\tthis\tchapter),\tor\n(3)\tnutrient\tmalabsorption.\nTABLE\t26.4\nGastric\tSurgery–Related\tNutrition\tComplications\nSurgical\tProcedure\nPotential\tComplications\nVagotomy
|
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] |
Surgical\tProcedure\nPotential\tComplications\nVagotomy\nTotal\tgastric\tand\ttruncal\nvagotomy\nImpairs\tmotor\tfunction\tof\tstomach\nGastric\tstasis\tand\tpoor\tgastric\temptying\nTotal\tgastrectomy\nEarly\tsatiety,\tnausea,\tvomiting\nWeight\tloss\nInadequate\tbile\tacids\tand\tpancreatic\tenzymes\tavailable\n\tbecause\tof\nanastomotic\tchanges\nMalabsorption
|
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because\tof\nanastomotic\tchanges\nMalabsorption\nProtein-energy\tmalnutrition\nAnemia\nDumping\tsyndrome\nBezoar\tformation\nVitamin\tB\n12\n\tdeficiency\nMetabolic\tbone\tdisease\nSubtotal\tgastrectomy\twith\nvagotomy\nEarly\tsatiety\nDelayed\tgastric\temptying\nRapid\temptying\tof\thypertonic\tfluids\nCresci\tG\tet\tal:\t\nNutrition\tessentials\tof\tgeneral\tsurgery
|
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] |
Cresci\tG\tet\tal:\t\nNutrition\tessentials\tof\tgeneral\tsurgery\n,\ted\t5,\tLippincott\tWilliams\t&\tWilkins,\t2013,\tTable\t3–13,\n\tp\t72;\tRollins,\tCJ\t(2015):\tChapter\t23,\nDrug-Nutrient\tInteractions\twith\tGastrointestinal\tDrugs.\tIn\t\nThe\tHealth\tProfessional’s\tGuide\tto\tGastrointestinal\tNutrition\n\t(pp.\t296–311).\tChicago\tIL:\nCathy\tImmartino.
|
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] |
(pp.\t296–311).\tChicago\tIL:\nCathy\tImmartino.\nPatients\twith\tcertain\tgastric\tsurgeries,\tsuch\tas\tBillroth\tII,\tresult\tin\ta\tmismatch\tin\ttiming\tof\tfood\nentry\tinto\tthe\tsmall\tintestine\tand\tthe\trelease\tand\tinteraction\twith\tbile\tand\tpancreatic\tenzymes,\ncontributing\tto\timpaired\tnutrient\tdigestion\tand\tabsorption.\tPatients\twho\tare\tlactose\ttolerant\tbefore
|
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] |
gastric\tsurgery\tmay\texperience\trelative\tlactase\tdeficiency,\teither\tbecause\tfood\tenters\tthe\tsmall\nintestine\tfurther\tdownstream\tfrom\tadequate\tlactase\tpresence,\tor\tbecause\tthe\trate\tof\ttransit\tthrough\nthe\tproximal\tsmall\tintestine\tis\tincreased.\tBecause\tof\tthe\tcomplications\tof\treflux\tor\tdumping\nsyndrome
|
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] |
syndrome\n\tassociated\twith\ttraditional\tgastrectomies,\tother\tprocedures\tare\tused,\tincluding\ttruncal,\nselective,\tor\tparietal\tcell\tvagotomy;\tpyloromyotomy;\tantrectomy;\tRoux-en-Y\tesophagojejunostomy;\nloop\tesophagojejunostomy;\tand\tpouches\tor\treservoirs\tmade\tfrom\tjejunal\tor\tileocecal\tsegments.
|
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] |
Some\tchronic\tnutritional\tcomplications\tthat\tcan\toccur\tafter\tgastric\tsurgery\tinclude\tanemia,\nosteoporosis,\tand\tselect\n\tvitamin\tand\tmineral\tdeficiencies\tresulting\tfrom\tinadequate\tintake\tand\tor\nmalabsorption.\tIron\tdeficiency\tmay\tbe\tattributed\tto\tloss\tof\tacid\tsecretion\tbecause\tgastric\tacid
|
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] |
normally\tfacilitates\tthe\treduction\tof\tiron\tcompounds,\tallowing\ttheir\tabsorption.\tRapid\ttransit\tand\ndiminished\tcontact\tof\tdietary\tiron\twith\tsites\tof\tiron\tabsorption\tcan\talso\tlead\tto\tiron\tdeficiency.\nVitamin\tB\n12\n\tdeficiency\tmay\tcause\n\ta\tmegaloblastic\tanemia\t(see\t\nChapter\t31\n).\tIf\tthe\tamount\tof
|
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] |
a\tmegaloblastic\tanemia\t(see\t\nChapter\t31\n).\tIf\tthe\tamount\tof\ngastric\tmucosa\tis\treduced,\tintrinsic\tfactor\tmay\tnot\tbe\tproduced\tin\tquantities\tadequate\tto\tallow\tfor\ncomplete\tvitamin\tB\n12\n\tabsorption,\tand\tpernicious\tanemia\tmay\tresult.\tBacterial\tovergrowth\tin\tthe\nproximal\tsmall\tbowel\tor\tthe\tafferent\tloop\tcontributes\tto\tvitamin\tB\n12
|
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proximal\tsmall\tbowel\tor\tthe\tafferent\tloop\tcontributes\tto\tvitamin\tB\n12\n\tdepletion\tbecause\tbacteria\ncompete\twith\tthe\thost\tfor\tuse\tof\tthe\tvitamin.\tTherefore\n\tafter\tgastrectomy\tpatients\tshould\treceive\nprophylactic\tvitamin\tB\n12\n\tsupplementation\t(injections)\tor\ttake\tsynthetic\toral\tsupplementation.\nDumping\tsyndrome\nEtiology\nThe\t\ndumping\tsyndrome
|
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Dumping\tsyndrome\nEtiology\nThe\t\ndumping\tsyndrome\n\tis\ta\tcomplex\tGI\tand\tvasomotor\tresponse\tto\tthe\tpresence\tof\tlarge\nquantities\tof\thypertonic\tfoods\tand\tliquids\tin\tthe\tproximal\tsmall\tintestine.\tDumping\tsyndrome\tusually\noccurs\tas\ta\tresult\tof\tsurgical\tprocedures\n\tthat\tallow\texcessive\tamounts\tof\tliquid\tor\tsolid\tfoods\tto
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result\tof\ttotal\tor\tpartial\tgastrectomy,\tmanipulation\tof\n\tthe\tpylorus,\tfundoplication,\tvagotomy,\tand\nsome\tgastric\tbypass\tprocedures\tfor\tobesity.\tAs\ta\tresult\tof\tbetter\tmedical\tmanagement\tof\tpeptic
|
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] |
ulcers,\tuse\tof\tselective\tvagotomies,\tand\tnewer\tsurgical\tprocedures\tto\tavoid\tcomplications,\tclassic\ndumping\tis\tencountered\tless\tfrequently\tin\tclinical\tpractice.\nPathophysiology\nSymptoms\tcan\tbe\tdivided\tinto\ttwo\ttypes\tor\tstages\tof\tdumping\tof\tsolids\tand\tliquids\n\tinto\tthe\tsmall\nintestine,\tand\tcharacteristics\tand\tsymptom\tseverity\tvary\tbetween\tpatients:
|
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] |
•\t\nEarly\tdumping\t(within\t10\tto\t30\tminutes\tpostprandially)\tis\tcharacterized\tby\tGI\tand\nvasomotor\tsymptoms,\twhich\tinclude\tabdominal\tpain,\tbloating,\tnausea,\tvomiting,\tdiarrhea,\nheadache,\tflushing,\tfatigue,\tand\thypotension.\tThese\tsymptoms\tlikely\toccur\tbecause\tof\tthe\nrapid\tinflux\tof\thyperosmolar\tcontents\tinto
|
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] |
rapid\tinflux\tof\thyperosmolar\tcontents\tinto\n\tthe\tduodenum\tor\tsmall\tintestine.\tA\tsubsequent\nfluid\tshift\tfrom\tthe\tintravascular\tcompartment\tto\tthe\tintestinal\tlumen\toccurs,\tresulting\tin\nsmall\tintestine\tdistention,\tpotentially\tcausing\tcramps\tand\tbloating.\n•\t\nLate\tdumping\t(1\tto\t3\thours\tpostprandially)\tresults\tin\tsymptoms\tthat\tare\tpredominantly
|
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vasomotor\tand\tinclude\tperspiration,\tweakness,\tconfusion,\tshakiness,\thunger,\tand\nhypoglycemia.\tLate\tdumping\n\tis\tlikely\tthe\tresult\tof\treactive\thypoglycemia.\tRapid\tdelivery,\tas\nwell\tas\thydrolysis\tand\tabsorption\tof\tcarbohydrates,\tproduces\tan\texaggerated\trise\tin\tinsulin
|
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] |
level\tand\ta\tsubsequent\tdecline\tin\tblood\tglucose.\tThe\trapid\tchanges\tin\tblood\tglucose\tand\tthe\nsecretion\tof\tgut\tpeptides,\tglucose\tinsulinotropic\tpolypeptide,\tand\tglucagon-like\tpolypeptide-\n1\tappear\tto\tbe\tat\tleast\tpartly\tresponsible\tfor\tthe\n\tlate\tsymptoms\t(\nDeloose\tet\tal,\t2014\n).\nMedical\tmanagement
|
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] |
late\tsymptoms\t(\nDeloose\tet\tal,\t2014\n).\nMedical\tmanagement\nMedical\tintervention\ttypically\tinvolves\tdietary\tchanges\tas\tthe\tinitial\ttreatment,\tand\tthey\tare\tusually\neffective.\tHowever,\tin\t3%\tto\t5%\tof\tpatients,\tsevere\tdumping\tpersists\tdespite\tdietary\tchange.\tIn\tthese
|
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] |
patients,\tmedications\tmay\tbe\tused\tto\tslow\tgastric\temptying\tand\tdelay\ttransit\tof\tfood\tthrough\tthe\tGI\ntract.\tSome,\tsuch\tas\tacarbose,\n\tinhibit\talpha\tglycoside\thydrolase\tand\tinterfere\twith\tcarbohydrate\nabsorption,\tand\toctreotide,\ta\tsomatostatin\tanalog,\tinhibits\tinsulin\trelease\t(see\t\nTable\t26.3\n\tfor
|
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] |
Table\t26.3\n\tfor\ncommon\tmedications).\tRarely,\tsurgical\tintervention\tis\tused\tto\ttreat\tdumping\tsyndrome.\nMedical\tnutrition\ttherapy\nPatients\twith\tdumping\tsyndrome\tmay\texperience\tweight\tloss\tand\tmalnutrition\tcaused\tby\tinadequate\nintake,\tmalabsorption,\n\tor\ta\tcombination\tof\tboth.\tThe\tprime\tobjective\tof\tnutrition\ttherapy\tis\tto
|
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] |
restore\tnutrition\tstatus\tand\tquality\tof\tlife.\tBecause\tthey\tare\tdigested\tmore\tslowly,\tproteins\tand\tfats\nare\tbetter\ttolerated\tthan\tcarbohydrates,\tparticularly\tsimple\tcarbohydrates.\tSimple\tcarbohydrates\nsuch\tas\tlactose,\tsucrose,\tfructose,\tglucose,\tand\tdextrose\tare\thydrolyzed\trapidly\tand\tshould\tbe\nlimited,\tbut\tcomplex\tcarbohydrates
|
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] |
limited,\tbut\tcomplex\tcarbohydrates\n\t(starches)\tcan\tbe\tincluded\tin\tthe\tdiet.\nLiquids\tleave\tthe\tstomach\tand\tenter\tthe\tjejunum\trapidly;\tthus,\tsome\tpatients\thave\ttrouble\ntolerating\tliquids\twith\tmeals.\tPatients\twith\tsevere\tdumping\tmay\tbenefit\tfrom\tlimiting\tthe\tamount\tof
|
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] |
liquids\ttaken\twith\tmeals\tand\tdrinking\tliquids\tbetween\tmeals\twithout\tsolid\tfood.\tReclining\n(approximately\t30\tdegrees)\tafter\tmeals\tmay\talso\tminimize\tseverity\tof\tsymptoms.\nThe\tuse\tof\tsoluble\tfiber\tsupplements,\tparticularly\tpectin\tor\tgums\t(e.g.,\tguar)\tcan\tbe\tbeneficial\tin
|
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] |
managing\tdumping\tsyndrome\tbecause\tof\tfiber’s\tability\tto\tform\tgels\twith\tcarbohydrates\tand\tfluids\nand\tdelay\tGI\ttransit.\tPatients\tmay\tneed\tto\tbe\ttaught\tabout\tportion\tsizes\tof\tfoods,\tespecially\tof\ncarbohydrate\tfoods\tsuch\tas\tjuices,\tsoft\tdrinks,\tdesserts,\tand\tmilk.\tThe\texchange\tlist\tgiven\tin\nAppendix\t18
|
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] |
Appendix\t18\n\tcan\tbe\tused\tto\tcalculate\tcarbohydrate\tintake\tand\tteach\tabout\tcarbohydrate\tcontrol.\nPostgastrectomy\tpatients\toften\tdo\tnot\ttolerate\tlactose,\tbut\tsmall\tamounts\t(e.g.,\t6\tg\tor\tless\tper\nmeal)\tmay\tbe\ttolerated\tat\tone\ttime.\tPatients\ttypically\tdo\tbetter\twith\tcheeses\tor\tunsweetened\tyogurt
|
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] |
than\twith\tfluid\tmilk.\tNondairy\tmilks\tare\talso\tuseful\twhen\tnecessary.\tVitamin\tD\tand\tcalcium\nsupplements\tmay\tbe\tneeded\n\twhen\tintake\tis\tinadequate.\tCommercial\tlactase-containing\tproducts\tare\navailable\tfor\tthose\twith\tsignificant\tlactose\tmalabsorption\t(see\t\nChapter\t27\n\tfor\tfurther\tdiscussion\tof\nlactose\tintolerance\tand\tits\tmanagement).
|
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for\tfurther\tdiscussion\tof\nlactose\tintolerance\tand\tits\tmanagement).\nWhen\tsteatorrhea\t(greater\tthan\t7%\tof\tdietary\tfat\tin\tthe\tstool)\texists,\treduced-fat\tformulas\tor\npancreatic\tenzymes\tmay\tbe\tbeneficial.\t\nBox\t26.7\n\tprovides\tgeneral\tnutrition\tguidelines\tfor\n\tpatients
|
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0.09786425530910492,
-0.005926419980823994
] |
Box\t26.7\n\tprovides\tgeneral\tnutrition\tguidelines\tfor\n\tpatients\nwith\tdumping\tsyndrome\tafter\tgastric\tsurgery;\thowever,\teach\tdiet\tmust\tbe\tadjusted\tbased\ton\ta\ncareful\tdietary\tand\tsocial\thistory\tfrom\tthe\tpatient.\nBOX\t26.7\nBasic\tGuidelines\tfor\tDumping\tSyndrome\n1.\t\nEat\tsix\tto\teight\tsmall\tmeals\tthroughout\tthe\tday.\n2.
|
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] |
1.\t\nEat\tsix\tto\teight\tsmall\tmeals\tthroughout\tthe\tday.\n2.\t\nLimit\tfluids\tto\t4\tounces\t(½\tcup)\tat\ta\tmeal,\tjust\tenough\tto\trinse\tfood\tdown.\n3.\t\nDrink\tremaining\tfluids\tat\tleast\t30\tto\t40\tminutes\n\tbefore\tand\tafter\tmeals.\n4.\t\nEat\tslowly\tand\tchew\tfoods\tthoroughly.\tSome\tmay\tbenefit\tfrom\tsoft,\tground,\tor\tpureed
|
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] |
foods,\tor\tthose\tthat\tare\talready\tbroken\tdown,\tsuch\tas\tground\tmeats.\n5.\t\nAvoid\textreme\ttemperatures\tof\tfoods\t(very\thot\tor\tvery\tcold).\n6.\t\nUse\tseasonings\tand\tspices\tas\ttolerated\t(may\twant\tto\tavoid\tpepper,\thot\tsauce).\n7.\t\nLie\tdown\tor\trecline\tfor\tat\tleast\t30\tminutes\tafter\teating.\n8.\t\nLimit
|
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] |
Lie\tdown\tor\trecline\tfor\tat\tleast\t30\tminutes\tafter\teating.\n8.\t\nLimit\n\tsimple\tcarbohydrate\tfoods\tand\tliquids\twith\tmore\tthan\t12\tgrams\tof\tsugar\tper\tserving.\nExamples:\tfruit\tjuice,\tGatorade,\tPowerade,\tKool\tAid,\tsweet\ttea,\tsucrose,\thoney,\tjelly,\tcorn\nsyrup,\tcookies,\tpie,\tdoughnuts.\tIncrease\tcomplex\tcarbohydrate\tfoods\tsuch\tas\twhole\tgrains
|
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] |
and\tfoods\tmade\twith\tthem,\tand\tpotatoes.\n9.\t\nChoose\tfoods\tthat\tare\thigher\tin\tsoluble\tfiber.\tSome\texamples\tof\tthese\tfoods\tinclude\tapples,\noats,\tbeets,\tcarrots,\tand\tbeans.
|
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] |
10.\t\nInclude\ta\tprotein-containing\tfood\tat\teach\tmeal.\n11.\t\nAdd\ta\tserving\tof\tfat\tsuch\tas\tolive\toil,\tnut\tbutter,\tor\tavocado\tto\tmeals\tas\ttolerated\tto\nencourage\tslower\tgastric\temptying.\tMinimize\tfried\tfoods,\tchips,\tcookies,\thot\tdogs,\tand\nother\tgreasy\tfoods.\n12.\t\nMilk\tand\tdairy\tproducts\tmay\tnot\tbe\ttolerated\tin\tthe\tlactose\tintolerant.\tIntroduce\tthese
|
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] |
slowly\tin\tthe\tdiet\n\tif\tthey\twere\ttolerated\tpreoperatively.\n13.\t\nAvoid\tsugar\talcohols\tsuch\tas\tsorbitol,\txylitol,\tmannitol,\tand\tmaltitol,\tas\tthese\tmay\nexacerbate\tsymptoms.\nUniversity\tof\tVirginia\tHealth\tSystem.\tAnti-Dumping\tDiet,\t\nhttps://uvahealth.com/services/digestive-\nhealth/images-and-docs/dumping-syndrome.pdf
|
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health/images-and-docs/dumping-syndrome.pdf\n;\tCresci\tGA\t(2015):\tChapter\t14,\tGastrointestinal\tTract\nSurgery.\tIn\t\nThe\tHealth\tProfessional’s\tGuide\tto\tGastrointestinal\n\tNutrition\n\t(pp.168–181).\tChicago\tIL:\tCathy\nImmartino.\nGastroparesis\nEtiology\nGastroparesis\n\tis\ta\tsyndrome\tof\tdelayed\tgastric\temptying\twithout\tevidence\tof\tmechanical
|
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0.04527948424220085,
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] |
obstruction\tand\tis\ta\tcomplex\tand\tpotentially\tdebilitating\tcondition.\tThe\tnature\tof\tgastroparesis\tis\ncomplex\tin\tpart\tbecause\tgastric\tmotility\tis\torchestrated\tby\ta\tvariety\tof\tchemical\tand\tneurologic\nfactors.\tViral\tinfection,\n\tdiabetes,\tand\tsurgeries\tare\tthe\tmost\tcommon\tcauses\tfor\tgastroparesis;
|
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] |
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