Explain Nutritional Support Management for gastric cancer?
The 'dumping syndrome' can be greatly minimized or prevented by adhering strictly to an antidumping dict. In general, such a diet is high in protein, has adequate fat, is low in total carbohydrate, particularly simple carbohydrate restricted in fluids at meal time. Small frequent meals, say six times per day should be served. Patient should be discouraged to lie down immediately after the meal, instead, encourage them to be in a reclining position for a short period of time. The use of soluble fibre such as pectin derivative has been reported to prolong gastric emptying, to decrease dumping and to minimize the fall in blood sugar. If steatorrhoea (loss of fat in the stools) is significant, replacement of a portion of LCT (long-chain triglycerides) with MCT (medium chain triglycerides) will be helpful, The patient will be able to tolerate this better. Pancreatic extract can also be tried to rule out luminal pancreatic enzyme insufficiency.
Insufficiency of pancreatic enzyme(s) may result from rapid entry of food and fluid into the upper small bowel or from a pancreatic secretory defect or from both. Deficiencies of vitamins and minerals can be prevented by adequate oral administration of iron with ascorbic acid and by supplementing both water-soluble and fat-soluble vitamins. Monthly injections of 100 micrograms of vitamin B,, are required because the extensive gastric resection will eventually result in vitamin B,, deficiency. Milk is found to be poorly tolerated by these patients. They can be asked to drink milk in small amounts frequently over the day (or to drink lactase treated milk if available) or to use yoghurt as tolerated. In case these approaches are of no use, the more soluble calcium salts should be given in divided doses. At least one gram of calcium should be given for a day. Antiemetics (drugs to prevent nausea or vomiting) are used in treatment of chemotherapy induced nausea and vomiting. Antiemetics become absolutely necessary to help better adherence to therapeutic programmes and better intake of food and fluids. Weight loss seen in these patients is mainly due to poor food intake. In addition to this, discomfort associated with eating may result from esophagitis secondary to bile regurgitation, anorexia associated with depression or the side effects of drugs and/or radiation. Hence, a careful diet history, conform an adequate basis for dietary modifications.
If the above prescribed dietary management does not prevent the dumping syndrome or there is no adequate food intake to maintain gain body weight, slow-drip tube feedings of a complete formula is recommended. Because of the slow entry of food into the upper intestine by this technique, dumping is not likely to occur. Such feedings may need Lo be given only during the period of chemotherapy. This will help to improve the appetite. When patients remain seriously anorexia following chemotherapy, tube feedings at night are helpful.