Medical Nutrition Therapy Case Study: Harold, a 58 year old grocery store manage
ID: 123848 • Letter: M
Question
Medical Nutrition Therapy Case Study: Harold, a 58 year old grocery store manager, had reported waking frequently in the middle of the night with abdominal pain and sometimes in the middle of the afternoon. Harold had lost his appetite as he feared what he ate caused the pain. Harold did not report any other condition. After having an endoscopy at a hospital, Harold was diagnosed with a peptic ulcer. Analysis of a tissue sample taken from the site showed that Harold also had an infection that was caused by Helicobacter pylori bacteria.
H. pylori has been identified in the saliva of infected individuals and may be spread via this fluid. H. pylori bacteria survives the acid environment in the stomach because they produce enzymes that neutralize stomach acids. They also move through the mucous membrane lining the stomach or duodenum and take up residence in the underlying connective tissue where pepsin and hydrochloric acid can enter and cause further damage to the wall of the stomach or duodenum.
Question: The physician scheduled a an appointment for another endoscopy procedure in 6 months, what monitoring and evaluation would you plan for Harold, as his Registered Dietian?
Explanation / Answer
H pylori is a complicating gastric infection which causes ulceration of gastric lining. Its role in causation of gastric carcinoma is also important to understand, as therapy should be directed toward complete eradication of the bacilli. Hence the role of dietary changes and prolonged medication cannot be understated in order to prevent relapse and re-ulcering surfaces that can lead to premalignant lesions. The entire aim of nutritional therapy should be to to prevent the increased secretion of peptic chloride with a combination of tissue healing and repair of ulcered suface. Foods rich in dietary fibre, vitamin A, zinc, selenium, vitamin C, vitamin B, folic acid and iron should be advised.Fruits like cranberry, rasperries and other fibre rich fruits are to be encouraged in the recovery phase especially as they contain flavinoids. Vegetables like carrots, beans, spinach, garlic, celery are rich in flavinoids and antioxidants. Cereals like oats, barley and whole grain foods are especially good as they contain high dietary fibre. Foods with high fat sources like potatos, fries, oily foods, red meat , cheesy sauces, chocolates should be strictly avoided as they delay gastric emptying. Lean protein rich foods like skimed dairy products, lentils, fish and lean meat are to be used as substitutes to protein. Alcohol, smoking and caffeine consumption should be prohibited. Light exercise regimens to be followed also.