Articles
Stomach Cancer
In the early stages, stomach cancer does not always cause symptoms. The earliest symptoms can include heartburn and indigestion. As the cancer progresses symptoms will become more evident and can include nausea, vomiting, continual feeling of fullness despite not eating, fatigue, abdominal swelling, blood in the vomit and black coloured stools. Such symptoms are likely to affect ones food intake and it is likely nutritional depletion has already begun by the time of diagnosis.
The most common treatment of stomach cancer is surgery with either partial or complete removal of the stomach. Chemotherapy may also be required post surgery. Pre surgical nutrition intervention should focus on maintaining nutrient intake and boosting the body’s natural immune defence prior to taxing surgery. High kilojoule and high protein liquid supplements will likely be used. Dietary therapy becomes predominantly important post surgery.
Surgery decreasing the size of the stomach, decreases the stomach’s capacity to store food and also decreases the ability of the stomach to stretch to accommodate more food. If the entire stomach has been removed, the small bowel will need to stretch to accommodate larger volumes of food and this takes time. This leads to a very early feeling of fullness, even after a small meal or snack. Eating smaller, more frequent meals is recommended. This can mean eating hourly post surgery and increasing the time between meals and the size of meals as it begins to feel more comfortable. Avoiding high fibre foods will also help, as these create a feeling of fullness quickly. Avoid drinking directly before or during meals to allow more space in the stomach for food.
Indigestion and reflux are common post stomach surgery. It is recommended to avoid fizzy drinks, alcohol and spicy foods, as well as any other foods that aggravate symptoms. Sipping peppermint oil in hot water can help relieve trapped wind and its associated pain. Reflux can lead to pain and inflammation. Reflux medications such as Gaviscon will help to relieve discomfort.
Dumping syndrome is a common issue post stomach surgery. It is caused by food moving too rapidly into the small bowel, due to a decrease in stomach size or complete stomach removal. There are two types of dumping syndrome, early and late, each with a different set of symptoms. Early dumping syndrome tends to occur within 30 minutes of eating. When the food reaches the small bowel, water is drawn into the bowel quickly, causing a sudden drop in blood pressure. Symptoms include dizziness, feeling faint and even heart palpitations which can last 10-15 minutes. Late dumping syndrome occurs in the hours after eating. It is caused by the sudden presence of sugars in the small bowel, leading to a rapid rise in blood sugar. The body tries to compensate by producing a rapid surge of insulin, intended to drop blood sugars back to normal. This can lead to a feeling of faintness. Abdominal pain and diarrhoea often accompany symptoms of dumping syndrome. To avoid dumping syndrome, try to eat meals slowly to allow a slower digestion. Reduce the amount of high GI and high sugar foods consumed, and introduce high fibre foods as tolerated. Adding healthy fats to meals will also decrease the rate of digestion. Avoid soups and liquid meals that can pass through the GIT too quickly. Eating smaller meals will decrease the stress placed on the small bowel at any one time.
Diarrhoea is common after partial and complete stomach removal. It occurs due to the removal of the vagus nerve that controls the muscular movement of the digestive system and digestive juice production. Diarrhoea can come on very suddenly and can last anywhere from days to weeks. If diarrhoea persists an anti- diarrhoea medication may be required. Slowly increasing fibre as tolerated can help.
Morning vomiting occurs in partial stomach removal due to the build up of bile and digestive juices in the small intestine overnight. This build up can spill back into the small stomach area, causing nausea and vomiting. Indigestion and stomach emptying medication can help however they tend to only reduce symptoms and not alleviate them completely. If symptoms do not improve it is recommended to speak to your doctor.
Each of these issues can drastically reduce food intake and lead to nutritional deficiency and malnutrition. Weight maintenance is a common problem. A dietitian can assess your dietary status and recommend ways to increase the kilojoule/calorie content of the diet without further complicating symptoms. Vitamin supplementation may also be recommended, in particular calcium, vitamin D and iron, as these nutrients are enhanced by gastric acid to allow absorption in the duodenum. A dietitian will help to ensure your diet is also rich in these nutrients. They may also recommend a liquid food supplement to ensure nutrient and kilojoule/calorie is sufficient for weight maintenance or weight gain. After complete stomach removal, vitamin B12 injections are usually necessary.
It is important to be aware of a condition known as ‘narrowing of the join’. After complete stomach removal, the lower end of the oesophagus is joined to the upper end of the small intestine. In some cases this join can start to narrow, making swallowing difficult and painful. If this occurs see your doctor immediately, as any difficulty in eating leads to decreased intake and eventual weight loss and malnutrition. The doctor may be able to stretch the narrowing, or a stent may be required. If narrowing occurs, speak to a dietitian about changing the texture of foods to make swallowing easier. They can also recommend liquid food replacements to ensure nutrient intake is up kept.
Added to site on : Tuesday, 1 January 2013