Skip to main content
SpringerLink
Log in

Nutrition Therapy for Dysphagia, EoE, Gastroparesis, GERD, and Liver Disease

  • Living reference work entry
  • First Online:
Geriatric Gastroenterology

  • 244 Accesses

Abstract

The nutrition management of older individuals who suffer from gastrointestinal (GI) disorders often requires a multifaceted approach to management. This chapter details the nutritional management of six GI disorders encountered in the geriatric population: dysphagia, eosinophilic esophagitis (EoE), gastroparesis, gastroesophageal reflux disease (GERD), nonalcoholic fatty liver disease (NAFLD), and cirrhosis. Disorders that affect the upper GI tract such as dysphagia, EoE, GERD, and gastroparesis can impact a patient’s ability to eat. Nutritional interventions are paramount to prevent or correct unintentional weight loss, nutrient deficiencies, or protein-calorie malnutrition. Diets tailored to various swallowing disorders are detailed in the chapter. Therapeutic interventions such as an elimination diet can be used in place of medications for those with EoE. Nutrition therapy is also key in treating individuals with liver disease. Individuals with cirrhosis often have difficulty meeting their nutrient needs besides requiring sodium restriction in diet. Additionally, diet and exercise are the only known treatments for NAFLD with the goal of weight loss to improve hepatic inflammation. Clinicians who care for older individuals will benefit from recognizing the importance of diet therapy for these GI disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Agarwal E, Miller M, Yaxley A, Isenring E. Malnutrition in the elderly: a narrative review. Maturitas. 2013;76:296–302. https://doi.org/10.1016/j.maturitas.2013.07.013.

    Article  PubMed  CAS  Google Scholar 

  • Albhaisi S, Sanyal A. Recent advances in understanding and managing non-alcoholic fatty liver disease. F1000Res. 2018; https://doi.org/10.12688/f1000research.14421.1.

  • Arias A, González-Cervera J, Tenias J, Lucendo AJ. Efficacy of dietary interventions for inducing histologic remission in patients with eosinophilic esophagitis: a systematic review and meta-analysis. Gastroenterology. 2014;146:1639–48.

    PubMed  Google Scholar 

  • Basaranoglu M, Basaranoglu G, Bugianesi E. Carbohydrate intake and nonalcoholic fatty liver disease: fructose as a weapon of mass destruction. Hepatobiliary Surg Nutr. 2015;4:109–16. https://doi.org/10.3978/j.issn.2304-3881.2014.11.05.

    Article  PubMed  PubMed Central  Google Scholar 

  • Bertolotti M, Lonardo A, Mussi C, Baldelli E, Pellegrini E, Ballestri S, et al. Nonalcoholic fatty liver disease and aging: epidemiology to management. World J Gastroenterol. 2014;20:14185–204. https://doi.org/10.3748/wjg.v20.i39.14185.

    Article  PubMed  PubMed Central  Google Scholar 

  • Biecker E. Diagnosis and therapy of ascites in liver cirrhosis. World J Gastroenterol. 2011;17:1237–48. https://doi.org/10.3748/wjg.v17.i10.1237.

    Article  PubMed  PubMed Central  Google Scholar 

  • Camilleri M. Integrated upper gastrointestinal response to food intake. Gastroenterology. 2006;131(2):640–58.

    PubMed  CAS  Google Scholar 

  • Camilleri M, Parkman H, Shafi M, Abell T, Gerson L. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108(1):18–37.

    PubMed  CAS  Google Scholar 

  • Chopra S, Lai M. Management of nonalcoholic fatty liver disease in adults. UpToDate. 2019. https://www.uptodate.com/contents/management-of-nonalcoholic-fatty-liver-disease-inadults? search=treating%20nafld&source= search_result&selectedTitle=1~128&usage_type=default&display_rank=1. Accessed 10 Apr 2019.

  • Cianferoni A, Skuker M, Whitehorn TB, Hunter H, Venter C, Spergel JM. Food avoidance strategies in eosinophilic oesophagitis. Clin Exp Allergy. 2019;49:269–84.

    PubMed  Google Scholar 

  • Commisso A, Lim F. Lifestyle modifications in adults and older adults with chronic gastroesophageal reflux disease (GERD). Crit Care Nurs Quart. 2019;42(1):64–74.

    Google Scholar 

  • Cotton CC, Durban R, Dellon ES. Illuminating elimination diets: controversies regarding treatment of eosinophilic disorders. Dig Dis Sci. 2019;64(6):1401–8.

    PubMed  PubMed Central  Google Scholar 

  • Dellon ES, Gonsalves N, Hirano I, Furuta GT, Liacouras CA, Katzka DA. ACG clinical guideline: evidenced based approach to the diagnosis and management of esophageal eosinophilia and eosinophilic esophagitis (EoE). Am J Gastroenterol. 2013;108(5):679–92.

    PubMed  Google Scholar 

  • DiCecco S, Francisco-Ziller N. Nutrition in alcoholic liver disease. Nutr Clin Pract. 2006; https://doi.org/10.1177/0115426506021003245.

  • Doerfler B, Bryce P, Hirano I, Gonslaves N. A practical approach to implementing dietary therapy in adults with eosinophilic esophagitis: the Chicago experience. Dis Esophagus. 2015;28(1):42–58.

    PubMed  CAS  Google Scholar 

  • Ekberg O, Hamdy S, Woisard V, Wuttge-Hannig A, Ortega P. Social and psychological burden of dysphagia: its impact on diagnosis and treatment. Dysphagia. 2002;17(2):139–46.

    PubMed  Google Scholar 

  • Erwin EA, Asti L, Hemming T, Kelleher KJ. A decade of hospital discharges related to eosinophilic esophagitis. J Pediatr Gastroenterol Nutr. 2012;54:427–9.

    PubMed  PubMed Central  Google Scholar 

  • European Association for the Study of the Liver. EASL clinical practice guidelines on nutrition in chronic liver disease. J Hepatol. 2019;70:172–93.

    Google Scholar 

  • Garcia J, Chambers E. Managing dysphagia through diet modifications. Am J Nurs. 2010;110(11):26–33.

    PubMed  Google Scholar 

  • Ghaemi A, Taleban F, Hekmatdoost A, Rafiei A, Hosseini V, Amiri Z, et al. How much weight loss is effective on nonalcoholic fatty liver disease? Hepat Mon. 2013;13:15227. https://doi.org/10.5812/hepatmon.15227.

    Article  Google Scholar 

  • Goldberg E, Chopra S. Cirrhosis in adults: etiologies, clinical manifestations, and diagnosis. UpToDate. 2018. https://www.uptodate.com/contents/cirrhosis-in-adults-etiologies-clinical-manifestations-and-diagnosis. Accessed 5 May 2019.

  • Gonsalves N. Approach to the young patient in the era of eosinophilic esophagitis. Curr Gastroenterol Rep. 2010;12(3):181–8.

    PubMed  Google Scholar 

  • Gonsalves N, Ritz S, Yang GY, Ditto A, Hirano I. A prospective clinical trial of allergy testing and food elimination diets in adults with eosinophilic esophagitis. Gastroenterology. 2008;132:378.

    Google Scholar 

  • Gonsalves N, Yang GY, Doerfler B, et al. Elimination diet effectively treats eosinophilic esophagitis in adults; food reintroduction identifies causative factors. Gastroenterology. 2012;142(7):1451–9.

    PubMed  Google Scholar 

  • Groetch M, Venter C, Skypala I, Vlieg-Boerstra B, Grimshaw K, Durban R, Cassin A, Henry M, Kliewer K, Kabbash L, Atkins D, Nowak-Węgrzyn A, Holbreich M, Chehade M. Dietary therapy and nutrition management of eosinophilic esophagitis: a work group report of the American Academy of Allergy, Asthma, and Immunology. J Allergy Clin Immunol Pract. 2017;5(2):312–324.e29.

    PubMed  Google Scholar 

  • Guo Y, Tian Z, Jiang N, Ding X, Mao T, Jing X. Effects of late evening snack on cirrhotic patients: a systematic review and meta-analysis. Gastroenterol Res Pract. 2018;3:1–10. https://doi.org/10.1155/2018/9189062.

    Article  CAS  Google Scholar 

  • Habib M, Parekh N. Pathophysiology, diagnosis, and treatment of gastroparesis. Support Line. 2013;35(1):19–25.

    Google Scholar 

  • Healthy People. Health related quality of life and well being: measuring HRQOL. 2020. https://www.healthypeople.gov/2020/topics-objectives/topic/health-related-quality-of-life-well-being. Accessed 29 July 2019.

  • Heidelbaugh J, Sherbondy M. Cirrhosis and chronic liver failure: part II. Complications and treatment. Am Fam Physician. 2006;74:767–76.

    PubMed  Google Scholar 

  • Homko C, Duffy F, Friedenberg F, Boden G, Parkman H. Effect of dietary fat and food consistency on gastroparesis symptoms in patients with gastroparesis. Neurogastroenterol Motil. 2015;27(4):501–8.

    PubMed  CAS  Google Scholar 

  • IDDSI – International Dysphagia Diet Standardisation Initiative [Internet]. Iddsi.org. 2020. Available from: https://iddsi.org/. Cited 30 Mar 2020.

  • Jarosz M, Taraszewska A. Risk factors for gastroesophageal reflux disease – the role of diet. Gastroenterology Rev. 2014;5:297–301.

    Google Scholar 

  • Juakiem W, Torres D, Harrison S. Nutrition in cirrhosis and chronic liver disease. Clin Liver Dis. 2014;18:179–90.

    PubMed  Google Scholar 

  • Kagalwalla AF, Sentongo TA, Ritz S, et al. Effect of six food elimination diet on clinical and histologic outcomes in eosinophilic esophagitis. Clin Gastroenterol Hepatol. 2006;4:1097–102.

    PubMed  Google Scholar 

  • Kahrilas P, Gupta R. Mechanisms of acid reflux associated with cigarette smoking. Gut. 1990;31(1):4–10.

    Google Scholar 

  • Kang J, Kang J. Lifestyle measures in the management of gastro-oesophageal reflux disease: clinical and pathophysiological considerations. Ther Adv Chronic Disease. 2015;6(2):51–64.

    Google Scholar 

  • Kargulewicz A, Stankowiak-Kulpa H, Grzymisławski M. Dietary recommendations for patients with nonalcoholic fatty liver disease. Prz Gastroenterol. 2014;9:18–23. https://doi.org/10.5114/pg.2014.40845.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  • Kelly K, Lazenby A, Rowe P, Yardley J, Perman J, Sampson H. Eosinophilic esophagitis attributed to gastroesophageal reflux: improvement with an amino acid-based formula. Gastroenterology. 1995;109(5):1503–12.

    PubMed  CAS  Google Scholar 

  • Kubo A, Block G, Quesenberry C, Buffler P, Corley D. Dietary guideline adherence for gastroesophageal reflux disease. BMC Gastroenterol. 2014;14(1).

    Google Scholar 

  • Liacouras CA, Furuta GT, Hirano I, Atkins D, Attwood SE, et al. Eosinophilic esophagitis: updated consensus recommendations for children and adults. J Allergy Clin Immunol. 2011;128:3–20.

    PubMed  Google Scholar 

  • Lucendo AJ, Molina-infante J, Arias A, et al. Guidelines on eosinophilic esophagitis: evidence based statements and recommendations for diagnosis and management in children and adults. United European Gastroenterol J. 2017;5:335–58.

    PubMed  PubMed Central  Google Scholar 

  • McCarthy E. Nonalcoholic fatty liver disease. Todays Diet. 2014;16:48.

    Google Scholar 

  • Mendelsohn A. The effects of reflux on the elderly. Otolaryng Clin N Am. 2018;51(4):779–87.

    Google Scholar 

  • Meyer R, De Koker C, Dziubak R, Venter C, Dominguez-Ortega G, Cutts R, et al. Malnutrition in children with food allergies in the UK. J Hum Nutr Diet. 2013;27(3):227–35.

    PubMed  Google Scholar 

  • Molina-Infante J, Arias A, Barrio J, Sanchez-Cazalilla M, Lucendo J. Four-food group elimination diet for adult eosinophilic esophagitis: a prospective multicenter study. J Allergy Clin Immunol. 2014;134:1093–9.

    PubMed  Google Scholar 

  • Molina-Infante J, Arias Á, Alcedo J, Garcia-Romero R, Casabona-Frances S, Prieto-Garcia A, et al. Step-up empiric elimination diet for pediatric and adult eosinophilic esophagitis: the 2-4-6 study. J Allergy Clin Immun. 2018;141(4):1365–72.

    Google Scholar 

  • National Institute of Diabetes and Digestive and Kidney Diseases. Definition & facts of NAFLD & NASH, Bethesda. 2016. https://www.niddk.nih.gov/health-information/liver-disease/nafld-nash/definition-facts. Accessed 25 Mar 2019.

  • National Institute of Diabetes and Digestive and Kidney Diseases. Cirrhosis, Bethesda. 2018. https://www.niddk.nih.gov/health-information/liver-disease/cirrhosis/definition-facts. Accessed 5 May 2019.

  • Nawaz S, Tulunay-Ugur O. Dysphagia in the older patient. Otolaryngol Clin N Am. 2018;51(4):769–77.

    Google Scholar 

  • Ness-Jensen E, Hveem K, El-Serag H, Lagergren J. Lifestyle intervention in gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2016;14(2):175–82. e1–3.

    Google Scholar 

  • Ness-Jensen E, Lagergren J. Tobacco smoking, alcohol consumption and gastro-oesophageal reflux disease. Best Pract Res Cl Ga. 2017;31(5):501–8.

    Google Scholar 

  • Olausson E, Alpsten M, Larsson A, Mattsson H, Andersson H, Attvall S. Small particle size of a solid meal increases gastric emptying and late postprandial glycaemic response in diabetic subjects with gastroparesis. Diabetes Res Clin Pr. 2008;80(2):231–7.

    Google Scholar 

  • Olausson E, Störsrud S, Grundin H, Isaksson M, Attvall S, Simrén M. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol. 2014;109(3):375–85.

    PubMed  CAS  Google Scholar 

  • Olendzki B. Patient education: low sodium diet (beyond the basics). UpToDate. 2017. https://www.uptodate.com/contents/low-sodium-diet-beyond-the-basics?topicRef=1256&source=see_link. Accessed 5 May 209.

  • Parkman H, Yates K, Hasler W, Nguyan L, Pasricha P, Snape W, et al. Dietary intake and nutritional deficiencies in patients with diabetic or idiopathic gastroparesis. Gastroenterology. 2011;141(2):486–498.e7.

    PubMed  CAS  Google Scholar 

  • Parrish CR, McCray S. Gastroparesis and nutrition: the art. Pract Gastroenterol. 2011;XXXV(9):26–41.

    Google Scholar 

  • Pehl C, Wendl B, Pfeiffer A. White wine and beer induce gastro-oesophageal reflux in patients with reflux disease. Aliment Pharm Therap. 2006;23(11):1581–6.

    Google Scholar 

  • Perri G. Ascites in patients with cirrhosis. Can Fam Physician. 2013;59:1297–9.

    PubMed  PubMed Central  Google Scholar 

  • Philpott H, Dellon E. Histologic improvement after 6 weeks of dietary elimination for eosinophilic esophagitis may be insufficient to determine efficacy. Asia Pac Allergy. 2018;8(2):e20.

    PubMed  PubMed Central  Google Scholar 

  • Piesman M, Hwang I, Maydonovitch C, Wong R. Nocturnal reflux episodes following the administration of a standardized meal. Does timing matter?. Am J Gastroenterol. 2007;102(10):2128–34.

    Google Scholar 

  • Sanders MK. Bezoars: from mystical charms to medical and nutritional management. Pract Gastroenterol. 2004;XXVIII(1):37–50.

    Google Scholar 

  • Schvarcz E, Palmer M, Aman J, Horowitz M, Stridsberg M, Berne C. Physiological hyperglycemia slows gastric emptying in normal subjects and patients with insulin-dependent diabetes mellitus. Gastroenterology. 1997;113(1):60–6.

    PubMed  CAS  Google Scholar 

  • Soon IS, Butzner JD, Kaplan GG, deBruyn JC. Incidence and prevalence of eosinophilic esophagitis in children. J Pediatr Gastroenterol Nutr. 2013;57(1):72–80.

    PubMed  Google Scholar 

  • Spergel JM, Brown-Whitehorn T, Beausoleil JL, Shuker M, Liacoursas CA. Predictive values for skin prick test and atopy patch test for eosinophilic esophagitis. J Allergy Clin Immunol. 2007;119:509–11.

    PubMed  Google Scholar 

  • Spergel JM, Dellon ES, Liacouras CA, … Participants of AGREE. Summary of the updated international consensus diagnostic criteria for eosinophilic esophagitis: AGREE conference. Ann Allergy Asthma Immunol. 2018;121(3):281–4.

    Google Scholar 

  • Stein B, Everhart K, Lacy B. Gastroparesis. J Clin Gastroenterol. 2015;49(7):550–8.

    PubMed  Google Scholar 

  • Steward D, Wilson K, Kelly D, Patil M, Schwartzbauer H, Long J, et al. Proton pump inhibitor therapy for chronic laryngo-pharyngitis: a randomized placebo-control trial. Otolaryng Head Neck Surg. 2004;131(4):342–50.

    Google Scholar 

  • Such J, Runyon B. Ascites in adults with cirrhosis: initial therapy. UpToDate. 2018. https://www.uptodate.com/contents/ascites-in-adults-with-cirrhosis-initial-therapy#H6. Accessed 14 Apr 2019.

  • Suiter D, Easterling C. Update on current treatment and practice patterns for dysphagia. Top Geriatr Rehabil J. 2007;23(3):197–210.

    Google Scholar 

  • Taft TH, Kern E, Keefer L, Burstein D, Hirano I. Qualitative assessment of patient-reported outcomes in adults with eosinophilic esophagitis. J Clin Gastroenterol. 2011a;45(9):769–74.

    PubMed  Google Scholar 

  • Taft TH, Kern E, Kwiatek MA, Hirano I, Gonsalves N, Keefer L. The adult eosinophilic oesophagitis quality of life questionnaire: a new measure of health-related quality of life. Aliment Pharmacol Ther. 2011b;34:790–8.

    PubMed  CAS  Google Scholar 

  • Tajiri K, Shimizu Y. Liver physiology and liver diseases in the elderly. World J Gastroenterol. 2013;19:8459–67. https://doi.org/10.3748/wjg.v19.i46.8459.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tandon P, Gramlich L. Nutrition assessment in chronic liver disease. UpToDate. 2019. https://www.uptodate.com/contents/nutritional-assessment-in-chronic-liver-disease#. Accessed 5 May 2019.

  • Tendler D. Pathogenesis of nonalcoholic fatty liver disease. UpToDate. 2018. https://www.uptodate.com/contents/pathogenesis-of-nonalcoholic-fatty-liver-disease?search=nafld&topicRef=3625&source=see_link. Accessed 10 Apr 2019.

  • Thompson T. Gluten contamination of commercial oat products in the United States. N Engl J Med. 2004;351:2021–2.

    PubMed  CAS  Google Scholar 

  • Tsien C, McCullough A, Dasarathy S. Late evening snack: exploiting a period of anabolic opportunity in cirrhosis. J Gastroenterol Hepatol. 2011;27:430–41. https://doi.org/10.1111/j.1440-1746.2011.06951.x.

    Article  CAS  Google Scholar 

  • Tulunay-Ugur O, Eibling D. Geriatric dysphagia. Clin Geriatr Med. 2018;34(2):183–9.

    PubMed  Google Scholar 

  • Vasques J, Guerrerio C, Sousa J, Pinto M, Cortez-Pinto M. Nutritional support in cirrhotic patients with sarcopenia. Clin Nutr ESPEN. 2019;33:12–7. https://doi.org/10.1016/j.clnesp.2019.07.011.

    Article  PubMed  Google Scholar 

  • Wang R, Hirano I, Doerfler B, Zalewski A, Gonsalves N, Taft TH. Assessing adherence and barriers to long term elimination diet in adults with eosinophilic esophagitis. Dig Dis Sci. 2018;63(7):1756–62.

    PubMed  PubMed Central  Google Scholar 

  • Yamanaka-Okumura H, Nakamura T, Takeuchi H, Miyake H, Katayama T, Arai H, et al. Effect of late evening snack with rice ball on energy metabolism in liver cirrhosis. Eur J Clin Nutr. 2006;60:1067–72.

    PubMed  CAS  Google Scholar 

  • Younossi Z, Koenig A, Abdelatif D, Fazel Y, Henry L, Wymer M. Global epidemiology of nonalcoholic fatty liver disease – meta-analytic assessment of prevalence, incidence and outcomes. Hepatology. 2016;64:73–84. https://doi.org/10.1002/hep.28431.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Michigan Medicine, Ann Arbor, MI, USA

    Emily Haller

  2. Adult Liver Transplant/Hepatology Clinic, Michigan Medicine, Ann Arbor, MI, USA

    Lorraine Bonkowski

  3. Section of Gastroenterology, Hepatology and Nutrition, University of Chicago Medicine, Chicago, IL, USA

    Courtney Schuchmann

  4. Northwestern Medicine, Division of Gastroenterology & Hepatology, Digestive Health Center, Chicago, IL, USA

    Bethany Doerfler

Authors
  1. Emily Haller
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lorraine Bonkowski
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Courtney Schuchmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Bethany Doerfler
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emily Haller .

Editor information

Editors and Affiliations

  1. Saint Peter's Healthcare System, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Albert Einstein College of Medicine, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

Rights and permissions

Reprints and permissions

Copyright information

© 2020 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

Haller, E., Bonkowski, L., Schuchmann, C., Doerfler, B. (2020). Nutrition Therapy for Dysphagia, EoE, Gastroparesis, GERD, and Liver Disease. In: Pitchumoni, C., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-319-90761-1_107-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90761-1_107-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90761-1

  • Online ISBN: 978-3-319-90761-1

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation