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Main points of diet after gastrectomy
After gastrectomy, gastrointestinal motility and digestion and absorption need to be gradually restored, and the wounds on the gastrointestinal tract also need time to heal, so the diet needs to gradually transition from thin to dry and from less to more. According to the new concept of accelerated rehabilitation surgery, drinking water or enteral nutrition can be started on 1 day after operation, so our suggestions for dietary transition after gastrectomy are as follows (if the surgeon has other instructions according to the patient's condition, please follow the doctor's advice):

(1) After the operation (or after the gastric tube is removed), you can eat all liquid foods, including water, rice soup without residue, enteral nutrient solution, etc. for about 1~3 days.

(2) Four to seven days after the operation (or after the gastric tube is removed), an appropriate amount of semi-liquid food, including porridge, noodles, custard, yogurt, vegetable paste, fruit paste and meat paste, can be added to the total liquid food.

(3) The above-mentioned semi-liquid diet should be given priority to 1~2 weeks after operation;

(4) On the basis of a semi-liquid diet, an appropriate amount of digestible soft food can be added 2-4 weeks after operation, including soft rice, steamed bread, meat stuffing (such as steamed bread, wonton, meatballs), fish, whole eggs, fresh vegetables and fruits, etc.

(5) You can eat normally one month after operation, but it is still recommended to be light, digestible and fully cooked. If a few patients with stomach or stomach wall resection can speed up the above transition, they can generally enter the ordinary diet in about two weeks.

In addition, due to the weakening or lack of gastric crushing function, patients after gastrectomy should pay special attention to fully cooked food, chew slowly when eating, and suggest chewing 20~30 times per bite, replacing gastric crushing function with whole mouth chewing.

After gastrectomy, the volume of remnant stomach or substitute stomach is obviously smaller than that of normal stomach, and the food content is also obviously reduced, so patients undergoing subtotal gastrectomy or total gastrectomy should follow the principle of eating less and eating more. In the early postoperative period, the frequency of eating can be 6~ 10 times a day, and it is appropriate to eat 1/3~ 1/4 before operation. After 3~6 months of recovery, the patient's remnant stomach (a small part of the remaining stomach) or stomach replacement (the function of replacing the stomach after the upper segment of the small intestine is expanded) can be compensated. At this time, the frequency of patients' eating can be significantly reduced, but they usually need to eat 4~6 times a day.

Normal people have a structure called pylorus between the stomach and the small intestine, which controls the food in the stomach to slowly enter the small intestine. After gastrectomy, due to the absence of pylorus, the stomach volume decreases, and a large amount of hypertonic chyme may quickly enter the small intestine after meals, leading to an increase in blood sugar and a decrease in blood volume. Some patients may have symptoms such as fullness, nausea, sweating and tachycardia, which is called "dumping syndrome". Carbohydrate (staple food) and refined sugar (glucose, sucrose, maltose, etc. ) It is particularly easy to lead to the increase of intestinal osmotic pressure, so patients with gastrectomy can appropriately reduce the intake of staple food and try to reduce the intake of refined sugar. Eating less and eating more meals, and lying down after meals are also helpful to improve or eliminate such symptoms, so it is recommended that patients with gastrectomy lie down after meals 1 hour before exercising.

For the diet of people with benign diseases, please refer to the Dietary Guide for China Residents. Its main contents include: 1, food is diverse, mainly cereals; 2. Dynamic balance of diet and healthy weight; 3. Eat more vegetables, milk and soybeans; 4. Eat fish, poultry, eggs and lean meat in moderation; 5, less salt and less oil, control sugar and limit alcohol.

For the diet of cancer patients, please refer to my other article "Health Suggestions for Cancer Patients". Its main contents include: 1, try to be thin, but avoid being underweight. 2. Exercise at least 30 minutes every day. 3. Avoid sugary drinks and limit high-calorie foods. 4. Eat more kinds of vegetables, fruits, whole grains and beans. 5. Limit the intake of red meat and avoid eating processed meat. 6. If you must drink alcohol, men should not exceed 2 cups a day, and women should not exceed 1 cup. 7. Limit the intake of sodium salt. 8. Don't rely on nutritional supplements to treat cancer. Special reminder: don't smoke or chew tobacco.

But for patients after gastrectomy, we should pay attention to the following points: 1, completely ban alcohol, because ethanol will directly damage gastric mucosa; 2. After gastrectomy, there is no "disinfection" effect of gastric acid, and the digestive ability decreases. Therefore, it is suggested that the food should be thoroughly cooked and not eaten raw meat, including raw fish and undercooked steak. 3, after gastrectomy, food can directly enter the small intestine, so the temperature should be appropriate, can not eat cold food. Note that "supercooled food" here usually refers to cold water or food directly taken out of the refrigerator; Generally, the temperature of fruit at room temperature is not very low, and the process of chewing can play a heating role, so it is not necessary to cook it before eating.

After gastrectomy, gastric acid secretion will decrease, affecting the absorption of iron in food; After gastrectomy, the decrease of endogenous factors (a substance produced by gastric mucosa to help the absorption of vitamin B 12) will lead to the deficiency of vitamin B 12. Anemia can occur in both cases, and blood routine should be checked regularly after gastrectomy to prevent anemia in time.

After gastrectomy, patients can appropriately increase iron-rich foods (egg yolk, animal liver, animal blood, red meat, beans, mushrooms, etc.). ) and foods rich in vitamin B 12 (red meat, animal offal, fish, poultry, shellfish and eggs, etc. However, due to the decreased absorption capacity, it is sometimes necessary to supplement iron and vitamin B 12 with drugs. ?

Insufficient nutrition intake and weight loss are easy to occur in the short term after gastrectomy. But in the long run, as long as you master reasonable dietary principles and actively cooperate with postoperative reexamination, you will have the opportunity to maintain a good nutritional status. I wish all patients a happy and healthy life.

Associate professor, deputy chief physician, doctor of surgery, tutor of master's degree.

Deputy Director of Anorectal Surgery, Sixth Affiliated Hospital of Sun Yat-sen University

Yi Shu of Anorectal Meridian-Zhu Qun

Young Member and Secretary-General of the Professional Committee of Colorectal and Anorectal Diseases of China Society of Integrated Traditional Chinese and Western Medicine

China medical doctor association anorectum professional Committee deputy director physician assessment branch

Member of the Third Council of World Zhonglian Anorectal Disease Professional Committee

Member of anorectal physician branch of Chinese Medical Association.

Member of the first professional Committee of transanal endoscopic minimally invasive surgery (research group) of the professional Committee of colorectal cancer of Chinese Medical Association.

Member of TEM (minimally invasive anorectal surgery) group of colorectal cancer professional committee of China Anti-cancer Association.

Standing Committee of Anorectal Professional Committee of Guangdong Traditional Chinese Medicine Association

Member of the Professional Committee of Gastrointestinal Surgery of Guangdong Medical Association.

Medical expert member of South China Medical Association of Guangdong Clinical Medical Association.

European Journal of Gastroenterology. Hepatology

Colorectal examination technique

He is good at the diagnosis and treatment of anorectal benign and malignant diseases, pelvic floor diseases, intractable constipation, complicated anal fistula, hemorrhoids, anal fissure and colorectal benign and malignant tumors.