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Clinical Hub,Patient Education,Health and Nutrition Facts For You,Nutrition

Modified Diet: Diet after Esophagectomy (368)

Modified Diet: Diet after Esophagectomy (368) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Nutrition

368

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Diet after Esophagectomy

After surgery on your esophagus you will need to follow a special diet because all or part
of the esophagus is removed. The stomach is made into a tube and is pulled up into the
chest to replace the part of the esophagus that has been removed. The new tube shaped
stomach is then reattached to allow food to move from the mouth to the rest of the
digestive tract. After surgery your stomach acts as a passageway for food to travel
through rather than storing the food you eat. Because of this, you will need to eat
smaller, more frequent meals. Your diet will slowly change as you heal. The diet is to
help make you more comfortable as you to eat.

Note: Each person tolerates food in a different way. Based on how you are doing after
surgery, your doctor may change your diet plan more slowly.

Feeding tube
Calories provide the building blocks you need to heal after surgery. This means good
nutrition is very important after surgery. Most patients who have an esophagectomy will
have a feeding tube put in at the time of surgery. This is to provide you with extra
nutrition until you can go back to your regular diet a few weeks after surgery. This tube is
called a jejunostomy tube or J-tube. The tube is inserted through the belly and into a part
of your small intestine called the jejunum. By using the J-tube your doctor can provide
liquid nutrition (tube feedings) for you after surgery until you are able to eat enough food
by mouth.

You will start tube feedings in the hospital early, a few days after surgery. Tube feedings
are most often started at a low, continuous rate. If you tolerate the feeds, no severe
cramping, nausea, and vomiting, the rate increases to provide more calories. As the rate
increases, you will be changed to cycled tube feedings. This means for a period of the
day the feedings will be shut off. Cycled feedings most often run from 3 pm to 9 am (18
hours), giving you 6 hours during the day to move around without being attached to the
feeding pump. The tube feeding rate may be decreased to a 12 hours cycled feeding (9
pm to 9 am) later on. It depends on the number of calories that you take by mouth. This
feeding plan will continue until your doctor believes you will be able to eat enough
nutrition to maintain your weight and heal well. Tube feedings are most often continued
when you go home after discharge. Depending on your progress, the J-tube will most
often be removed in the clinic at the time of your first post-op visit (about 2 weeks).

You should expect some cramping when the tube feedings start. The cramping is most
often brief and stops within a few days. There may also be some loose stools. This is due
to the change in the shape of your stomach from surgery and from the tube feedings. If
you are having a lot of, or uncomfortable, loose stools, we may change the type or rate of
your tube feeding to help.





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Common Eating Problems after Surgery

Feeling full after eating
ξ After surgery you will have a smaller stomach. Eat 6 to 8 small meals per day.
ξ Take small bites and chew your food fully.
ξ Limit fluids to ½ cup (4 ounces) with meals and to 1 cup (8 ounces) with snacks.
This will help with fullness and dumping/diarrhea

Reflux
ξ Avoid caffeine, carbonated drinks, alcohol, citrus, and tomato products.
ξ Avoid highly seasoned, spicy, or fried foods.
ξ Do not drink through a straw, chew gum or chew tobacco. This will decrease the
amount of air that you swallow and help with gas.
ξ Do not eat for at least 2 hours before going to bed.

Discomfort when swallowing
ξ Eat soft, moist foods because they are easier to digest and swallow.
ξ Avoid gummy foods such as bananas and doughy breads. If you feel like food is
“sticking” in your throat or you have pain behind the breast bone, try sipping a
small amount of fluid when eating solid foods. If these symptoms get worse,
notify your surgeon.
ξ A dilation (a procedure that helps open a narrowed esophagus due to scar tissue)
may help in treating symptoms of discomfort and difficulty with swallowing.
ξ Sit straight up when you eat. Gravity can help move food down. Continue to sit
up 30 to 60 minutes after you eat. This will help with acid reflux also.

Dumping
Dumping syndrome occurs when the food in the stomach empties too quickly into the
small intestine. Dumping can cause diarrhea, cramps, nausea, dizziness, bloating, and
light headedness.
ξ Limit fluids to ½ cup (4 ounces) with meals and to 1 cup (8 ounces) with snacks.
This will help with fullness and dumping.
ξ If you eat sweets limit them to the end of the meal. Sweets are digested more
quickly than other foods. Eating sweets first can lead to low blood sugar.
ξ Avoid very cold or very hot foods


What types of diets will I have?

Each person tolerates food in different ways and heals at a different rate. Your doctor
will change your diet based on your progress.
The 3 diets that you will be on:
1. Esophageal Clear Liquid Diet
2. Esophageal Full Liquid Diet
3. Esophageal Soft Diet




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1. Esophageal Clear Liquid Diet.
After your surgery your first diet will be Esophageal Clear Liquid. To be a clear liquid,
you must be able to see through it. (No pulp or cloudiness)

A Clear Liquid Diet:
ξ Clear juice (apple, cranberry, no citrus)
ξ Clear broth (chicken, beef and vegetable)
ξ Gelatin (such as Jell-O®)
ξ Tea (decaffeinated to avoid reflux)

Carbonated beverages are not allowed because it may cause gas.

2. Esophageal Full Liquid Diet
Along with the liquids in a clear liquid diet you may also have:
ξ Yogurt (without pieces of fruit or seeds)
ξ Cream of wheat or cream of rice hot cereal
ξ Ice cream
ξ Milk
ξ Pudding
ξ Strained soups (not tomato or broccoli)
ξ Liquid nutritional supplements like Ensure®, Carnation Instant Breakfast® or
Boost®.

Note: With dairy products you may, at first, have intolerance to lactose (not able to
digest milk sugar). Add small amounts of milk to your diet to see if you can tolerate
dairy or try lactose free milk-Lactaid®.


How to tell if a food item falls under a Full Liquid Diet
If you can imagine the food item going through a kitchen strainer, then it would be
considered a full liquid food item.

Examples of Full Liquid Diet:

Breakfast
Apple juice (4 ounces)
Cream of wheat cereal made with milk
or Lactaid®

Snack
Carnation Instant Breakfast® Drink (4
ounces)

Lunch
Creamed soup (strained), not tomato or
broccoli
Cranberry juice

Snack
Boost® nutritional supplement (4
ounces)

Dinner
Creamed soup (strained) not tomato or
broccoli
Vanilla pudding

Snack
Sherbet


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3. Esophageal Soft Diet
This diet should consist of bland, soft foods. We suggest cutting up tough meats into tiny
pieces and adding sauces or gravies to foods.

Food Group Food to choose Foods to avoid
Breads/Grains French toast
Crackers
Toasted bread
Soft breads, rolls, bagels, bread, bread
products that contain nuts, seeds, fresh or
dried fruit or are highly seasoned such as
garlic.
Sweet rolls, coffee cake, and doughnuts

Cereals Unsweetened dry cereal
Cooked cereals
Coarse cereals such as Grape Nuts® and
granola
Any cereals with fresh or dried fruit, sees,
or nuts

Drinks Regular milk as tolerated
De-caffeinated tea
Powdered drink mixes
Non-citrus juices such as
apple, cranberry, grape,
and blends
Chocolate milk
Soda (carbonated drinks)
Alcoholic beverages
Citrus juices such as orange juice,
grapefruit juice, lemon and lime
Drinks that contain herbal ingredients
such as St John’s Wort or ginseng
Caffeine containing drinks: coffee, tea,
decaf coffee

Meat and
Alternatives
Finely ground lean beef,
lamb, pork, veal, fish, and
poultry (not fried)
Eggs prepared any way
except fried
Cottage and ricotta cheese
Mild cheeses such as
American, Brick, baby
Swiss, or Mozzarella
Plain or flavored yogurt
Tofu and soy products
Smooth peanut butter
Casseroles prepared with
allowed ingredients
Tough meat with gristle
Highly seasoned, smoked, or fatty
meats/fish/poultry such as hot dogs,
lunch meats/cold cuts, sausage, bacon,
spareribs, goose, duck, beef brisket.
Chili and other spicy foods
Strong flavored cheeses such as sharp
cheddar and cheese that contains peppers
or other seasonings.
Crunchy peanut butter
Yogurt that contains nuts or seeds.

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Potato and
Starches
Peeled white or sweet
potatoes
White Rice and barley
Pasta such as enriched
noodles, spaghetti, and
macaroni.

Fried potatoes, potato skins
Fried, brown, or wild rice
Popcorn
Fruits Canned fruit
Cooked fruit (no skins)
Fruit juice, except citrus
Fresh or dried fruit
Citrus fruits and juices (orange,
grapefruit, lemon, lime)

Vegetables Cooked vegetables without
seeds or skins, such as
asparagus tips, baby peas,
carrots, green beans, and
winter squash.
Raw vegetables
Tomatoes, tomato juice, tomato sauce
or puree
Gas-producing vegetables such as
broccoli, Brussels sprouts, cabbage,
cauliflower, corn, cucumbers, green
peppers, onion, radishes, sauerkraut,
and turnips.
Dried beans, peas, and lentils.

Soups Mildly flavored meat stock
Creamed soups made with
allowed ingredients

Highly seasoned soups and tomato-
based soups.
Desserts Plain cakes, cookies,
puddings, custard, ice cream,
ice milk, frozen yogurt, and
sherbet.
Gelatins, popsicles
Desserts that contain chocolate,
coconut, nuts, seeds, fresh or dried
fruit, peppermint, or spearmint.

Sweets
Eat in
moderation and
with a meal.
Note: If
dumping
occurs, you
may need to
avoid these.
Sugar, syrup, honey, jelly,
and seedless jam.
Unfilled hard candies and
plain candies made with
allowed ingredients.
Molasses
Plain cake, cookies, pudding,
custard, ice cream, ice milk,
frozen yogurt, sherbet, fruit
ice, and popsicles.
Jam and marmalade, preserves made
with seeds or fruit.
Chocolate sweets/candy
Desserts containing chocolate, nuts,
coconut, seeds, peppermint, or
spearmint.
Dried or fresh fruit.


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Example Meal Plan for Esophageal
Soft Diet:

Breakfast
Canned fruit
Cold/hot cereal (½ cup)
1 slice toast
Margarine (1tsp)
Milk (1/2 cup)

Midmorning snack
Blended yogurt (1/2 cup)

Lunch
Meatloaf
Mashed potatoes (1/2 cup)
Low fat gravy
Canned peaches (1/2 cup)
Milk (1/2 cup)




Afternoon snack
Turkey (2 ounces)
4-6 saltine crackers
Fruit juice (1/2 cup)

Dinner
Roast chicken (ground) 3 ounces
Baked potato (small)
Margarine (2-3 tsp)
Cooked carrots (1/2 cup)
Canned pears (½ cup)
Milk (1/2 cup)

Bedtime snack
Cottage cheese (1/2 cup)
Canned peaches (1/2 cup)
Fruit juice (1/2 cup)



Returning to “Normal Diet”
There are no set rules as to when you will be able to return to eating the foods you ate
prior to your surgery. Each person’s situation is unique. In most cases, once the doctor
says that you may go back to you normal diet, you will want to add one new food item
each day and see how you tolerate the food before adding another food.



















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Teach Back:

What is the most important thing you learned from this handout?




What changes will you make in your diet/lifestyle, based on what you learned today?




If you are a UW Health patient and have more questions please contact UW Health at one
of the phone numbers listed below. You can also visit our website at
www.uwhealth.org/nutrition



Nutrition clinics for UW Hospital and Clinics (UWHC) and American Family Children’s
Hospital (AFCH) can be reached at: (608) 890-5500.

Nutrition clinics for UW Medical Foundation (UWMF) can be reached at:
(608) 287-2770
















Your health care team may have given you this information as part of your care. If so, please use it and call
if you have any questions. If this information was not given to you as part of your care, please check with
your doctor. This is not medical advice. This is not to be used for diagnosis or treatment of any medical
condition. Because each person’s health needs are different, you should talk with your doctor or others on
your health care team when using this information. If you have an emergency, please call 911. Copyright ©
2/2016 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Clinical
Nutrition Services Department and the Department of Nursing. HF#368

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Calorie Count Sheet

Please record the foods and amount you are eating when you get home. Bring this back
with you when you return for clinic visit




Type of food

Amount of food Weight Date