{"id":17277,"date":"2021-02-17T11:15:56","date_gmt":"2021-02-17T11:15:56","guid":{"rendered":"http:\/\/opa.org.uk\/sample-page\/opa-nutrition-and-digestive-issues\/"},"modified":"2021-03-18T16:35:45","modified_gmt":"2021-03-18T16:35:45","slug":"opa-nutrition-and-digestive-issues","status":"publish","type":"page","link":"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277","title":{"rendered":"OPA Nutrition and Digestive Issues"},"content":{"rendered":"<h1>Nutrition and Digestive Issues<\/h1>\n<h3>Notes from a talk given by Orla Hynes, Specialist Dietician<\/h3>\n<p><strong>Nutrition is often a problem because: <\/strong><\/p>\n<ul>\n<li>The anatomical location of the disease can lead to dysphagia [swallowing problems]\/delayed gastricemptying\/vomiting<\/li>\n<li>Decreased appetite, weight loss, metabolic alterations &amp; inflammatory state<\/li>\n<li>Treatments cause additional symptoms which impact on nutrition<\/li>\n<li>Long treatment pathway &ndash; using a combination of chemotherapy, radiotherapy, surgery<\/li>\n<\/ul>\n<p><strong>Nutrition plays a pivotal role across the entire pathway from diagnosis to survivorship:<\/strong><\/p>\n<ul>\n<li>Helps to preserve performance status [ie fitness for treatment]<\/li>\n<li>Helps to reduce the risk of treatment related toxicities so that you can get full doses of oncological<\/li>\n<li>Treatments<\/li>\n<li>Reduce risk of postoperative complications<\/li>\n<li>Maintain\/preserve quality of life<\/li>\n<\/ul>\n<p><strong>&lsquo;Survivorship&rsquo;: <\/strong><\/p>\n<ul>\n<li>Refers to living with or beyond cancer &#8211; What happens to the patients after they have finished theirtreatment?<\/li>\n<li>January 2010 National Cancer Survivorship Initiative published a vision document &ndash; findings that NHS are not meeting all cancer survivors&rsquo; needs following treatment<\/li>\n<li>How should we follow up our patients after surgery?&nbsp;<\/li>\n<\/ul>\n<p><strong>Aim: Quality of Life after Surgery:<\/strong><\/p>\n<p><strong><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/opa-old.voidappsdev.uk\/wp-content\/uploads\/2021\/02\/quality_of_life_after_surgery.jpg\" alt=\"\" width=\"620\" height=\"200\" \/><\/strong><\/p>\n<p><strong>Post Surgery:<\/strong><\/p>\n<ul>\n<li>Weight loss can be a problem<\/li>\n<li>Eating and drinking is difficult<\/li>\n<li>Maintaining a good nutritional status is challenging<\/li>\n<li>Dietary assessment is important &ndash; in determining the problems and strategies to help manage these<\/li>\n<li>Symptom management<\/li>\n<\/ul>\n<p><strong>Early Satiety [feeling full] and Reduced Appetite: <\/strong><\/p>\n<ul>\n<li>Smaller stomach capacity or none<\/li>\n<li>Disruption of gut hormones and innervation [vagotomy]<\/li>\n<li>Need to eat &lsquo;little &amp; often&rsquo; and be a &lsquo;grazer not a feaster&rsquo;<\/li>\n<li>&lsquo;Hard to change the habits of a lifetime&rsquo;<\/li>\n<li>&lsquo;Don&rsquo;t feel hungry&rsquo; is a common complaint<\/li>\n<li>Worsened by weight loss and malnutrition<\/li>\n<li>Eating pattern needs to be following a regime, rather than relying on feelings of hunger<\/li>\n<\/ul>\n<p><strong>Problems with Swallowing:<\/strong><\/p>\n<ul>\n<li>Bread and chunks of meat &ndash; likely to be a problem<\/li>\n<li>Sips of fluid with meals can help<\/li>\n<li>Anastomotic stricture &lsquo;tightening of the [surgical] join&rsquo;<\/li>\n<li>Sensation of food sticking<\/li>\n<li>Range of consistency &#8211; Solid foods Soft Diet Pureed Diet\/Liquids<\/li>\n<li>When dietary intake becomes a problem, intervention needs to be considered<\/li>\n<li>Dietary advice to ensure nutritional adequacy<\/li>\n<li>Endoscopy +\/- stretch<\/li>\n<\/ul>\n<p><strong>Acid Reflux:<\/strong><\/p>\n<ul>\n<li>Common to require antacids<\/li>\n<li>Loss of gastro-oesophageal junction, new position of stomach or &lsquo;gastric tube&rsquo;<\/li>\n<li>Watch out for other signs &ndash; cough or hoarse voice in the morning<\/li>\n<li>Important &ndash; can make &lsquo;tightening of the join&rsquo; worse<\/li>\n<li>Dietary advice of limited value as acid reflux is likely &#8211; but avoid obvious problematic foods&nbsp;<strong><\/strong><\/li>\n<\/ul>\n<p><strong>Bile Reflux:<\/strong><\/p>\n<ul>\n<li>Burning, bad taste, nausea<\/li>\n<li>Delayed gastric emptying&nbsp;<\/li>\n<li>Responds well to sucralfate suspension<\/li>\n<li>Endoscopy &amp; stretch<\/li>\n<li>Delayed Gastric Emptying: Can present as bad reflux<\/li>\n<li>Appetite in the morning but lessens as the day goes on<\/li>\n<li>Regurgitation\/Vomiting&nbsp;<\/li>\n<\/ul>\n<p><strong>Management:<\/strong><\/p>\n<ul>\n<li>Prokinetics [medication that stimulates the pylorus, bottom end of the stomach, to empty]<\/li>\n<li>Endoscopy &amp; stretch&nbsp;<\/li>\n<\/ul>\n<p><strong>Taste Changes:<\/strong><\/p>\n<ul>\n<li>Consequence of treatment<\/li>\n<li>Transient hopefully<\/li>\n<li>Bile reflux<\/li>\n<li>Check Vitamin B12 &amp; Zinc<\/li>\n<\/ul>\n<p><strong>Diarrhoea &amp; Steathorrhea [fatty stools]:<\/strong><\/p>\n<ul>\n<li>Decreased gut transit, intestinal hurry<\/li>\n<li>Loose stools to be expected after surgery<\/li>\n<li>Improves with time<\/li>\n<li>Loperamide\/Immodium<\/li>\n<li>Pale floating stools, difficult to flush &ndash; caused by fat malabsorption<\/li>\n<li>Very unpleasant, weight loss, malnutrition<\/li>\n<li>PERT &ndash; Pancreatic Enzyme Replacement Therapy<\/li>\n<li>Bile Salt malabsorption\n<ul>\n<li>Diagnosed by SeCAT scan<\/li>\n<li>Cholestyramine\/Colesevelam<\/li>\n<\/ul>\n<\/li>\n<li>Small bowel bacterial overgrowth (SIBO)\n<ul>\n<li>hydrogen breath test<\/li>\n<li>duodenal aspirates<\/li>\n<li>antibiotics<\/li>\n<li>probiotics<\/li>\n<\/ul>\n<\/li>\n<li>Dietary advice &ndash; last resort, fibre, fat, low FODMAPs. Aim to identify and treat cause is priority.&nbsp;<strong><\/strong><\/li>\n<\/ul>\n<p><strong>Diarrhoea, Bloating &amp; Flatulence:<\/strong><\/p>\n<ul>\n<li>Low FODMAPs diet\n<ul>\n<li>Fermentable Oligo-saccharides Disaccharides Monosaccharides And Polyols<\/li>\n<\/ul>\n<\/li>\n<li>Last resort&hellip;rule out other causes first&nbsp;<\/li>\n<li>Restrictive and complex, exclusion dietfor 8 weeks, slow and strategic reintroduction of foods. Motivation needed!<\/li>\n<li>May besuitable in a small number of patients, but not to be implemented without close supervision of a dietitian. Not to betried when on treatment.&nbsp;<\/li>\n<\/ul>\n<p><strong>Dumping Syndrome:<\/strong><strong><\/strong><\/p>\n<ul>\n<li>Early: bloating\/nausea\/fullness\/palpitations\/pain after eating\/flushing\/sweating\/faintness\/ loosestools or diarrhoea may follow<\/li>\n<li>Late: Tiredness\/tremor\/palpitations\/sweating\/giddiness<\/li>\n<li>Complex<\/li>\n<li>Dietary advice may help<\/li>\n<li>However seek advice from dietitian &ndash; avoid unnecessary restrictions<\/li>\n<li>********review other medications************<\/li>\n<li>Immodium\/loperamide<\/li>\n<li>Acarbose\/Octreotide<strong><\/strong><\/li>\n<\/ul>\n<p><strong>Fatigue:<\/strong><\/p>\n<ul>\n<li>Treatment, stress, anxiety, low mood\/depression<\/li>\n<li>Anaemia &ndash; reduced capacity tosend oxygen around the body<\/li>\n<li>Causes:\n<ul>\n<li>Chemotherapy<\/li>\n<li>Dietary deficiencies e.g. iron, Vitamin B12, folate<\/li>\n<li>Iron &amp; Vitamin B12 deficiency is common after surgery<\/li>\n<\/ul>\n<\/li>\n<li>Regular check of iron, vitamin B12&amp; folate<\/li>\n<li>Oral iron tablets, IV iron infusion, Vitamin B12 injections<\/li>\n<\/ul>\n<p><em>&copy; The Oesophageal Patients Association&nbsp;<\/em><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Nutrition and Digestive Issues Notes from a talk given by Orla Hynes, Specialist Dietician Nutrition is often a problem because: The anatomical location of the disease can lead to dysphagia [swallowing problems]\/delayed gastricemptying\/vomiting Decreased appetite, weight loss, metabolic alterations &amp; inflammatory state Treatments cause additional symptoms which impact on nutrition Long treatment pathway &ndash; using a combination of chemotherapy, radiotherapy, surgery Nutrition plays a pivotal role across the entire pathway from diagnosis to survivorship: Helps to preserve performance status [ie fitness for treatment] Helps to reduce the risk of treatment related toxicities so that you can get full doses of oncological Treatments Reduce risk of postoperative complications Maintain\/preserve quality of life &lsquo;Survivorship&rsquo;: Refers to living with or beyond cancer &#8211; What happens to the patients after they have finished theirtreatment? January 2010 National Cancer Survivorship Initiative published a vision document &ndash; findings that NHS are not meeting all cancer survivors&rsquo; needs following treatment How should we follow up our patients after surgery?&nbsp; Aim: Quality of Life after Surgery: Post Surgery: Weight loss can be a problem Eating and drinking is difficult Maintaining a good nutritional status is challenging Dietary assessment is important &ndash; in determining the problems and strategies to [&hellip;]<\/p>\n","protected":false},"author":4,"featured_media":0,"parent":0,"menu_order":141,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_acf_changed":false,"footnotes":""},"class_list":["post-17277","page","type-page","status-publish","hentry"],"acf":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v22.9 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>OPA Nutrition and Digestive Issues - The OPA<\/title>\n<meta name=\"robots\" content=\"noindex, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<meta property=\"og:locale\" content=\"en_GB\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"OPA Nutrition and Digestive Issues - The OPA\" \/>\n<meta property=\"og:description\" content=\"Nutrition and Digestive Issues Notes from a talk given by Orla Hynes, Specialist Dietician Nutrition is often a problem because: The anatomical location of the disease can lead to dysphagia [swallowing problems]\/delayed gastricemptying\/vomiting Decreased appetite, weight loss, metabolic alterations &amp; inflammatory state Treatments cause additional symptoms which impact on nutrition Long treatment pathway &ndash; using a combination of chemotherapy, radiotherapy, surgery Nutrition plays a pivotal role across the entire pathway from diagnosis to survivorship: Helps to preserve performance status [ie fitness for treatment] Helps to reduce the risk of treatment related toxicities so that you can get full doses of oncological Treatments Reduce risk of postoperative complications Maintain\/preserve quality of life &lsquo;Survivorship&rsquo;: Refers to living with or beyond cancer &#8211; What happens to the patients after they have finished theirtreatment? January 2010 National Cancer Survivorship Initiative published a vision document &ndash; findings that NHS are not meeting all cancer survivors&rsquo; needs following treatment How should we follow up our patients after surgery?&nbsp; Aim: Quality of Life after Surgery: Post Surgery: Weight loss can be a problem Eating and drinking is difficult Maintaining a good nutritional status is challenging Dietary assessment is important &ndash; in determining the problems and strategies to [&hellip;]\" \/>\n<meta property=\"og:url\" content=\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277\" \/>\n<meta property=\"og:site_name\" content=\"The OPA\" \/>\n<meta property=\"article:modified_time\" content=\"2021-03-18T16:35:45+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/opa-old.voidappsdev.uk\/wp-content\/uploads\/2021\/02\/quality_of_life_after_surgery.jpg\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:label1\" content=\"Estimated reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"4 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\/\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277\",\"url\":\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277\",\"name\":\"OPA Nutrition and Digestive Issues - The OPA\",\"isPartOf\":{\"@id\":\"https:\/\/opa-old.voidappsdev.uk\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277#primaryimage\"},\"image\":{\"@id\":\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277#primaryimage\"},\"thumbnailUrl\":\"https:\/\/opa-old.voidappsdev.uk\/wp-content\/uploads\/2021\/02\/quality_of_life_after_surgery.jpg\",\"datePublished\":\"2021-02-17T11:15:56+00:00\",\"dateModified\":\"2021-03-18T16:35:45+00:00\",\"breadcrumb\":{\"@id\":\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277#breadcrumb\"},\"inLanguage\":\"en-GB\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-GB\",\"@id\":\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277#primaryimage\",\"url\":\"https:\/\/opa-old.voidappsdev.uk\/wp-content\/uploads\/2021\/02\/quality_of_life_after_surgery.jpg\",\"contentUrl\":\"https:\/\/opa-old.voidappsdev.uk\/wp-content\/uploads\/2021\/02\/quality_of_life_after_surgery.jpg\",\"width\":620,\"height\":200},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\/\/opa-old.voidappsdev.uk\/?page_id=17277#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\/\/opa-old.voidappsdev.uk\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"OPA Nutrition and Digestive Issues\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\/\/opa-old.voidappsdev.uk\/#website\",\"url\":\"https:\/\/opa-old.voidappsdev.uk\/\",\"name\":\"The OPA\",\"description\":\"Caring for the cancer patient &amp; 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inflammatory state Treatments cause additional symptoms which impact on nutrition Long treatment pathway &ndash; using a combination of chemotherapy, radiotherapy, surgery Nutrition plays a pivotal role across the entire pathway from diagnosis to survivorship: Helps to preserve performance status [ie fitness for treatment] Helps to reduce the risk of treatment related toxicities so that you can get full doses of oncological Treatments Reduce risk of postoperative complications Maintain\/preserve quality of life &lsquo;Survivorship&rsquo;: Refers to living with or beyond cancer &#8211; What happens to the patients after they have finished theirtreatment? 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