gastro ig - dietitian · 2020-05-27 · 1.multilingual gluten free diet sheets (2015) gluten free...
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Hot Off The Press Pg 02
Nutrition in Action Pg 03
GASTRO IG NEWSLETTER
July 2015 I Issue 01
Practitioner Highlight Pg 09
Diner Update Pg 06
Medical Update Pg 7-8
Research & QI Pg 4-5
Welcome!
This is our first edition. This newsletter was born from my strong desire as convenor to try and reach more members than what I can with face to face CPD events. My vision is to provide a resource that you can quickly refer to for professional learning and development. In addition to the list serve we aim to make it a user friendly medium to share what might be helpful for practioners from all levels of gastro interest be it casual to specialisation. I also want to make sure that it is helpful for all types of practice including clinical, community, private, industry and all things innovative and different in between. We look forward to your input on how we can make each edition better and achieve this aim.
This edition has been the result of the volunteering efforts of six fantastic APD’s who have come together to share this vision. They are Lauren Reece, Felicity Ritorni, Lina Briek, Shamley Chand, Rachel Thompson and Debby Andersson.
Welcome to the Gastro IG Newsletter
I have placed myself as overseer and editor. My background is acute care clinical dietetics specialising in gastrointestinal surgery. Regardless of my frame of reference, I intend to do my upmost at providing something of benefit to all the different settings and applications of nutrition members of the Gastro IG belong to.
Enjoy!
Ruth Vo
Gastro IG ConvenorEditor
HOT OFF THE PRESSBy Lauren Reece & Rachel Thompson
We scoured the academic databases to provide a list of recent and relevant litera-ture in nutrition related gastroenterology topics.
Gut Microbiome
Dao MC, Everard A, Aron-Wisnewsky J, So-kolovska N, Prifti E, Verger E, et al. (2015) Akkermansia muciniphila and improved metabolic health during a dietary inter-vention in obesity: relationship with gut microbiome richness and ecology. Gut [In-ternet]. 2015 [Cited 2015 June 30]. Avail-able from http://gut.bmj.com/content/ear-ly/2015/05/22/gutjnl-2014-308778.short
ProbioticsGlanville J, King S, Guarner F, Hill C, Sand-ers ME. A review of the systematic review process and its applicability for use in eval-uating evidence for health claims on pro-biotic foods in the European Union. Nutr J [Internet]. 2015 [cited 2015 June 30];14:1-9. Available from: http://www.biomedcentral.com/
HOT OFF THE PRESS cont..
Immunonutrition
Mazaki T, Ishii Y, Murai I. Immunoenhancing Enteral and Parenteral Nutrition for Gastrointestinal Sur-gery: A Multiple treatments Meta-analysis. Ann Surg [Internet]. 2015 [cited 2015 June 30];261(4):662-669. Available from: www.annalsofsurgery.com
Pancreatic SurgeryNussbaum D, Penne K, Stinnett S, Speicher P, Co-cieru A, Blazer III D, et al. A standardized care plan is associated with shorter hospital length of stay in patients undergoing pancreaticoduodenec-tomy. J Surg Res[Internet]. 2015 [cited 2015 June 30];193:237-245. Available from: Science Direct
Probiotics & PaedsPärtty A, Kalliomäki M, Wacklin P, Salminen S, Iso-lauri E. A possible link between early probiotic inter-vention and the risk of neuropsychiatric disorders later in childhood: a randomized trial. Pediatr Res [Internet]. 2015 [cited 2015 June 30];77:823-828. Available from: http://www.nature.com/
Acute Pancreatitis & Enteral FeedingPropat G, Giljaca V, Hauser G, Štimac D. Enteral nu-trition formulations for acute pancreatitis. Cochrane DB Syst Rev [Internet]. 2015 [Cited 2015 June 20];3. Available from: http://www.thecochranelibrary.com
Gluten SensitivitySapone A, Leffler D, Mukherjee R. Non-Celiac gluten sensitivity- Where are we now in 2015?. Practical Gastroenterology [Internet]. 2015 [cited 2015 June 30];142:40-48. Available from: http://www.medi-cine.virginia.edu/clinical/departments/medicine/divisions/digestive-health/nutrition-support-team/nutrition-articles
Case Study
Sally is a 23-year-old female referred to you day 1 post total colectomy and formation of an end ileostomy on the background of colon cancer.
1) List three main nutritional issues you expect Sally to encounter in the first week post-op.
Sally’s renal function kept dropping every time the doctors would reduce the intravenous fluid (IVF) input. Suspicion from the surgeon was that Sally is not drinking enough orally to maintain renal function with an active ileostomy. Her ongoing requirement of IVF was delaying Sally’s discharge.
2) Bullet point three dietary strategies you would implement to assist this situation.
3) Bullet point three non-dietary strategies you would recommend to the team.
4) List three non-nutritional issues you expect Sally to encounter leading up to discharge.
Sally attends an outpatient appointment about 3 weeks post operation. Upon questioning, you discover Sally has lost weight, complains of excessive bloating and flatulence, she looks pale and fatigued with obvious angular stomatitis. Her stomal output had remained constant in amount since discharge at 1-1.2L/day; however, her oral intake had significantly reduced due to the abdominal discomfort she has been experiencing.
5) Beside quantity, what else should you consider about her stomal output? 6) Name the two conditions that could be causing the 1) abdominal discomfort, and 2) the paleness, fatigue and angular stomatitis?
Answers: will be provided next edition and via the list-serve in 1 month or via request to Ruth Vo
NUTRITION NUTRITION
IN ACTION
By Lina Breik
RESEARCH & QI By Lauren Reece & Felicity Ritorni
In the month of June an email was sent out to the Gastroenterology Interest group asking its members if they would like to feature information on current/completed research projects, QI projects, improvement initiatives and health promotion initiatives in the first gastro IG newsletter. We were blown away by the number of responses and by the great work dietitians are doing within the gastroenterology area. Here are a few of the responses we received. If you would like to feature your research/QI projects in future Gastro IG newsletters please keep an eye out for future emails.
The PEG tube decision: A Retrospective Audit of PEG insertions in 2013 and 2014
Background: Percutaneous Endoscopic Gastrostomy (PEG) tubes should be considered where their insertion is likely to improve quality of life. Current evidence supports a multi-disciplinary approach to making decisions around PEG insertion.Aim: Identify decision making processes that occurred prior to PEG insertion and investigate patient/carer perceptions of these.Methods: A retrospective audit will be conducted to identify: Dietetic involvement in decision making, consent process, patient capacity, presence of a family meeting, complications and mortality and patient living situation pre and post PEG insertion. A patient/carer phone survey will explore their PEG insertion decision process and the adequacy of information provided.
Outcome measures:- Understand the processes that occur to support the decision for PEG insertion- Understand the patient perspective of their PEG insertion decision.
Where to from here: The results of this project will be used to improve the decision making process around PEG insertion
Contact: Jenna Riley or Fiona Turnbull, Peninsula Health [email protected] or [email protected]
The Clinical Utility of Diagnostic Tests in the Treatment of Eosinophilic Oesophagitis
Background: Dietary therapy (elimination diets) is one of the main treatment options available for EoE. The efficacy of elimination diets is variable and detailed literature regarding long term use limited. EoE patients undergo repeated endoscopies for monitoring, these procedures pose risks such as perforation and incur a financial burden to patients.Aims: - Assess dietary intervention and management of EoE patients attending RPAH Allergy Unit.- Investigate the use of diagnostic blood tests in the diagnosis and monitoring of EoE.throughout the study period.
RESEARCH & QI cont...
Methods: In addition to comprehensive clinical and dietary review, study participants will have blood collection for specific IgE testing (ISAC array) and putative biomarkers. Patients will also be asked to complete 4-day weighed food diaries and a series of questionnaires throughout the study period.Outcome measures: Symptom and histological response (eosinophil count/HPF), nutritional adequacy and quality of life.
Where to from here: The study has commenced and will continue for 5 years.
Contact: Annabel Clancy, RPAH Allergy Unit [email protected].
Deficient colonic bacterial fermentation in patients with Ulcerative Colitis (UC): biomarkers and implications for future therapies
Background: Currently, we know little about how well the bacteria in the bowel of people with ulcerative colitis in remission handle dietary fibre.Aims: To investigate the physiological effects of a short-term, high vs low fibre diet in the large bowel of these individuals.
Methods: Individuals with UC in remission will be supplied with two diets differing in high or low amounts of indigestible carbohydrates. They will then swallow a wireless device that internally measures acidity and passage rate through the different sections of the gut.Outcome measures: - The amount of fibre fermented in the large bowel- Intraluminal pH profiles of the large intestine
Where to from here: The study is currently ongoing but participant recruitment has been challenging
Contact: CK Yao, Department of Gastroenterology, Monash University [email protected].
Learning the different types of pain patients present with in relation to FODMAPS and Food Chemical sensitivity.
Background: Over 40 years of experience and clinical research including IBS. Aims: to see any differences in presentation with regard to pain.Methods: Listening to the lived experience of patients with IBS painOutcome measures: - Pain suggestive of FODMAPS intolerance - Pain suggestive of food chemical sensitivity Where to: Publication of related articles on website to stimulate discussion. Contact: Joan Breakey [email protected] Website www.FoodIntolerancePro.com
Dietary Starch & Short Bowel Syndrome
Background: Austin Health’s intestinal rehabilitation and transplant unit is conducting research into the addition of starch to the diet of people with short bowel syndrome with colon in continuity to determine the effect on stool output. It is hypothesised that the addition of starch will reduce stool output via the stimulation of short chain fatty acids which promote fluid reabsorption in the colon. Aim: is to carry this out multicentre but barriers are recruitment. Contact: can be directed to Kate Hamilton Site: Austin Health (Melbourne) Best contact is email : [email protected]
DINER UPDATEBy Debby Andersson
1.Multilingual Gluten Free Diet Sheets (2015)
Gluten free diet sheets with cultural specific guidelines for those newly diagnosed with coeliac disease or requiring a gluten free diet. Languages include Arabic, Lebanese, Greek, Hindi, Italian, Persian, Farsi, Spanish, Tamil and Turkish
Multilingual Gluten Free Diet Sheets
2. Why Choose a Probiotic Yoghurt? (2015)
PowerPoint presentation by Duncan Hamm, Regional Industry Technical Manager - APAC, Singapore, Cultures & Enzymes Division Chr. Hansen Denmark. Presented at Jalna’s sponsored breakfast session at the DAA National Conference on Thursday 14th May 2015.
Why Choose a Probiotic Yoghurt?
3. Nutrition and the liver (Reviewed 2015)
The presentation covers: Review of the pathophysiology of the liver; Common liver diseases; Fatty liver, hepatitis C, cirrhosis, liver failure; Nutritional recommendations; Case study.
www.educationinnutrition.com.au
4. ACI: A Clinician’s Guide: Caring for people with gastrostomy tubes and devices (Last Review July 2015)
The Gastrostomy Guide provides health professionals with practical advice related to the different stages of the patient journey from deciding to initiate gastrostomy tube feeding to ongoing care and removing the tube or device, including transition or transfer of care.
5. Enteral Feed and Drug Nutrient Interactions (2015)
Several interactions must be considered when administering medications and enteral formulas together.
Enteral Feeds and Medication Awareness
Granisetron hydrochloride (antiemetic) (new product)
This medication is used to prevent nausea and vomiting due to cancer drug treatment (chemotherapy) and radiation therapy. It works by blocking one of the body’s chemicals (serotonin) that causes vomiting.
Transplantation
Simulect (Basiliximab) (updated information from TGA)
Basiliximab is used to prevent organ rejection in people who have received a kidney transplant. It is usually taken along with other medications (e.g., cyclosporine, corticosteroids) to allow the new organ to function normally. Basiliximab is an immunosuppressant drug known as a monoclonal antibody. It works by slowing down the body’s immune system to prevent the body from rejecting the new kidney after surgery (acute rejection).
Hepatitis
Sofosbuvir
Sofosbuvir is another antiviral drug that can be added to combination treatment for chronic hepatitis C. It is a direct-acting nucleotide polymerase inhibitor. The prodrug is converted to a nucleotide analogue in hepatocytes. This active analogue then binds to RNA polymerase which terminates RNA synthesis and inhibits viral replication.
MEDICAL UPDATE
By Debby Andersson
New Drugs
Cancers
Sorafenib
Sorafenib is used to treat advanced renal cell carcinoma (RCC; a type of cancer that begins in the kidneys). Sorafenib is also used to treat hepatocellular carcinoma (a type of liver cancer) that cannot be treated with surgery and a certain type of thyroid cancer that has spread to other parts of the body and cannot be treated with radioactive iodine. Sorafenib is in a class of medications called kinase inhibitors. It works by blocking the action of an abnormal protein that signals cancer cells to multiply. This helps stop the spread of cancer cells.
Capecitabine Myx (new product)
Capecitabine MYX belongs to a group of medicines called anti- neoplastic agents. Capecitabine MYX is used to treat cancer of the bowel and rectum (colorectal), breast and stomach and food pipe (oesophagus). It may be prescribed alone or in combination with other medicines used to treat cancer, such as chemotherapy medicines. The medicine contained in Capecitabine MYX, is converted by the liver and cancer cells to another medicine called 5-fluorouracil (also called 5-FU). It is 5-FU that acts to kill or stop the growth of cancer cells.
Antibiotics
Dificid
Used to treat infections of the lining of the colon particularly Clostridium difficile, Dificid (fidaxomicin) is a narrow-spectrum macrocyclic antibiotic.
Miscellaneous
Salpraz (Pantoprazole) (updated product information)
Pantoprazole is a proton pump inhibitor. It inhibits specifically and dose-proportionately H+ /K+ -ATPase, the enzyme which is responsible for gastric acid secretion in the parietal cells of the stomach.
New Treatments
Rashid T, et al. Novel strategies for liver therapy using stem cell. Gut January 2015 Vol 64 No. 1
The current gold standard of care in this setting is whole organ transplantation. Due to the increasing burden of disease within the population, however, the number of patients requiring transplantation far exceeds the number of available donor organs. As a result, many patients with liver insufficiency die prematurely. So an alternative, more tangible approach that targets more specific clinical problem could be to use hepatocytes in extra-hepatic anatomical sites to ‘bridge’ patients with liver insufficiency to transplant or self repair (E-HTx).
Gagner M. To bypass or switch? That is the question in obesity surgery. Nature Review (Gastroenterology & Hepatology) May 2015 Vol 12
In patients with a BMI >50, the debate continues on which surgery is best to achieve weight loss and improve health. In a new study, duodenal switch is superior to gastric bypass for weight loss, but patients suffered more adverse effects.
Basseville A, et al. Targeting KRAS and vitamin D receptor via microtubules. Nature Review (Clinical oncology) July 2015 (advanced online publication)
Pancreatic cancer remains a difficult-to-treat malignancy, yet nab-paclitaxel plus gemcitabine prolongs survival. Closer examination of the mechanism of action of nab-paclitaxel hints at a role for targeting KRAS. We discuss how nab-paclitaxel may be active in pancreatic cancer and how this informs the way forward to better treat patients with pancreatic cancer.
Yang, H.-C. & Kao, J.-H. HBV cure—can we pin our hopes on immunotherapy? Nature Review (Gastroenterology & Hepatology) 12, 129–131 (2015); published online 27 January 2015; doi:10.1038/nrgastro.2015.8
Therapeutic vaccines are considered to be able to reverse the dysfunctional immune state of chronic hepatitis B and thus hold the promise for HBV cure. Martin et al. developed a novel adenovirus-based therapeutic vaccine TG1050 and demonstrated its induction of long-lasting antiviral CD8+ T-cell immunity in mouse models of HBV persistence.
PRACTITIONER HIGHLIGHTDAY IN THE LIFE OF
TRANG SORIANOBy Shamley Chand
1. Could you please give me a background of your clinical experience and where you currently work? I’m currently working at Nepean hospital as the GI Surgical Dietitian, I’ve been in this role for 10 months. I’ve worked as a dietitian since 2007, at Auburn, Prince of Wales, Liverpool and Queen Mary’s Hospital in the UK, and about 2 years of part-time private practice. The clinical areas I’ve worked in include Diabetes outpatient (x2 yrs), gestational diabetes (1 year), Mental Health and Learning disabilities (9 months), age-care, cardiology, medical gastroenterology ( Liver + IBD for 2 years), surgical (including orthopaedic, vascular, H&N), and upper and lower GI surgery ( 2 1/2 years at various places)
2. What does your role entail as a gastrointestinal dietitian?Close working relationship and communication with surgeons, CNC, and fellow. Seeing pa-tients with GI surgical issues, deciding appropriate route of nutrition, liaising directly with surgeon, setting up service ( clinics, protocol/procedures), nursing in-service, department in-service, act as a resource person, supervision of level 1/ 2 staff, assist writing up district wide procedure ( TPN, Enteral, caring for tubes), ensure ward level and hospital practice in-line with best practice guidelines (ERAS, Pre-operative nutrition, TPN solutions), attend MDT meetings/ case conferences/ UGI grand grounds
3. On average how many gastrointestinal patients do you see a day?I mainly see surgical patients, average 10 patients/day
4. What are the main gastro-clinical patient group/s you see?SBO- resection, oesophagectomy, pancreatititis, ileostomy, gastrectomy, Hartman’s, post lap-arotomy complications (wound dehiscence, ileus, SBO)
5. How do you keep current on the changing science of gastro- nutrition?Journals, DAA IG, own research, reflecting on practice, peer discussion (doctors/surgeons/clinicians), membership ESPEN, ASPEN and using their resources
6. What’s the best thing you like about your job?Having more autonomy and greater input into the nutritional management, surgeons and doctors respecting and taking my recommendations/advice, which allows me to follow prac-tice guidelines and improving patient outcome.
7. What are some gastro related challenges you find about your job? Different practices (nutrition related) amongst surgeons
8. What are your most complex gastrointestinal patients you see?Patient with chyle leak and anastomosis leak post oesophagectomy on JJ feeds, or enterocu-taneous fistulae, or necrotising pancreatitis.
9. What are the main types of gastro related educations that you provide to your pa-tients? Eating post gastrectomy/oesophagectomy, HEHP, stoma diet, texture modified diets, PERT
Ruth VoGastro IG ConvenorEditor
GASTRO IG NEWSLETTER
July 2015 I Issue 01