Modified Diet: Diet after Esophagectomy HF#368

 

After surgery on your esophagus you will be asked to follow a special diet because all or part of the esophagus is removed. The stomach is pulled up into the chest and reattached to allow food to move from the mouth to the stomach.  When the stomach is stretched, it takes away the ability to eat large meals because there is no longer a large area to hold the food you eat. Your diet will slowly be advanced as you heal.  The diet is designed to help decrease any discomfort and allow you to eat. 

 

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

 

What if I need a feeding tube?

This is called a jejunostomy and means a feeding tube (J-tube). During surgery 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 for you after surgery until you are able to eat enough food by mouth. Feeding tubes are usually not placed during laparoscopic procedures.

 

We advise starting at a nonstop tube feeding for 24 hours a day.  Once you begin taking food by mouth we than suggest running the tube feeding only at night, for example from 6 pm to 6 am so that you are free to move about during the day.  This feeding plan will keep on until your doctor believes you will be able to eat enough nutrition to maintain your weight and heal quickly.

 

If your doctor feels that you are not able to eat enough food, then you may need to continue tube feedings at home as you recover.  If you go home with tube feeds, further orders and exact instructions will be given to you at that time.

 

Common Eating Problems after Surgery

 

Feeling full after eating.

After surgery you will have a smaller stomach.  Eat 6 to 8 small frequent meals per day.

Takes small bites and chew your food fully.

Limit fluids to ½ cup (4 ounces) with meals and to 1 cup (8 ounces) with snacks.  This will help with fullness and dumping.

 

Reflux.

Avoid caffeine, carbonated drinks, alcohol, citrus, and tomato products.

Avoid highly seasoned, spicy or fried foods.

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.

DO NOT eat for at least 2 hours before going to bed.

Discomfort when swallowing.

Eat soft, moist foods because they are easier to digest and swallow.  Avoid gummy foods such as bananas and some breads like Wonder Bread®. If you feel like food is “sticking” in your throat or have pain behind the breast bone try sipping a small amount of fluid when eating solid foods.

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.

Limit fluids to ½ cup (4 ounces) with meals and to 1 cup (8 ounces) with snacks.  This will help with fullness and dumping.

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.

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 so your doctor

will advance your diet based on your progress.

The 3 diets that you will experience:

 

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 the item. (No pulp or cloudiness)

 

A clear liquid diet consists:

Clear juice (apple, cranberry, no citrus)

Clear broth (chicken, beef and vegetable)

Gelatin (such as Jell-O®)

Tea (decaffeinated to avoid reflux)

 

Carbonated beverages are NOT allowed because it may cause gas.

2.  Esophageal Full liquid Diet

 In addition to the liquids in a clear liquid diet you may have:

 

• yogurt (without pieces of fruit or seeds)
• cream of wheat or cream of rice hot cereal
• ice cream
• milk
• pudding
• strained soups (not tomato or broccoli)
• liquid nutritional supplements like Ensure®, Carnation Instant Breakfast® or Boost®. 

 

Note:  With dairy products you may, at first, experience lactose intolerance (the inability to digest milksugar).  Add small amounts of milk to your diet to determine your tolerance 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

3.  Esophageal Soft Diet

This diet should consist of bland, soft foods. Cutting up tough meats into tiny pieces and adding sauces or gravies to foods is recommended.

 

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.

 

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.

 

Example Meal Plan for Esophageal Soft Diet:

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 due to each person’s unique situation.  In general, once the doctor states that you may resume you normal diet, you will want to add one new food item each day and observe how you tolerated the food before adding another food.

 

If you have more questions please contact UW Health at one of the phone numbers listed below.

 

 

 

Calorie Count Sheet

 

Please record the foods and quantity 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

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

The information provided should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Any duplication or distribution of the information contained herein is strictly prohibited.

Last Updated: 06/05/2012

Copyright © 04/15/2010 University of Wisconsin Hospitals and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#368

Print Health Fact For You