Post-Esophagectomy Diet

Karen Wagner, MS, RD, LDN and Katrina Claghorn, MS, RD, LDN
Abramson Cancer Center of the University of Pennsylvania
Last Modified: February 1, 2012

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Esophagectomy is a surgery to remove all or part of the esophagus, which is the tube food moves through on its way from the mouth to the stomach. When the esophagus is removed, the stomach is pulled up into the chest and reattached to keep the food passageway intact. This stretching of the stomach takes away the ability to eat large meals, as there is no longer a large "holding area" for food to be digested. Nutrition is an important part of healing and preventing weight loss after surgery. Patients can experience nausea, vomiting, acid reflux, and dumping syndrome. This article will review some ways to decrease these symptoms. Check with your healthcare team for specific recommendations for your case.

After the surgery, the remaining esophagus may not be able to move foods as easily from your mouth to your stomach. Certain foods can block the esophagus or be difficult to swallow. Some people complain of food "sticking", or have midsternal (behind the breast bone) pain. This may be prevented or resolved by sipping fluids when eating solid foods, chewing foods well, eating soft or chopped foods and avoiding tough, gummy, or stringy foods.

You may also get gastroesophageal reflux symptoms, such as heartburn and reflux of stomach contents, causing intolerance to certain foods, especially acidic, fatty, and very hot or very cold foods. Gas and bloating sometimes occur after surgery. Therefore, you may wish to avoid foods that are known to cause gas.

Each person is different and will tolerate different foods. Only you can decide which foods 'agree' with you and which don't. Below are ideas that may help you to manage your symptoms. The most important guide is how you feel after eating a food.

Diet Basics After Esophageal Surgery 

  • Foods to Avoid: 
    • Soft Bread/Rolls 
    • Tough, fibrous, or grisly meats 
    • Foods that cause discomfort 
  • Soft, moist foods may be more easily tolerated 
  • After surgery, remember that you may have decreased stomach capacity and less tolerance to certain foods. 
  • Try eating 6 small, nutrient-dense meals and snacks throughout the day, rather than 3 larger meals. Drink 6-8 eight-ounce glasses of fluids daily. 
  • If a food causes you discomfort, wait a week or two then retry the food. 
  • Take small bites and chew foods well. 
  • Stop eating when you start to feel full. 
  • Take a daily multivitamin. Chewable children's vitamins (2 per day) are usually well tolerated. A calcium supplement may be indicated – ask your surgeon. 

Tips to avoid heartburn or reflux 

  • Avoid clothing that is tight in the abdomen area. 
  • Limit caffeine intake (coffee, tea and cola drinks). Generally, decaffeinated beverages are better tolerated. 
  • Avoid chocolate. 
  • Limit or avoid alcohol. 
  • Sit upright after eating and remain in a sitting position for 45-60 minutes after eating. 
  • Avoid eating 3 hours before bedtime. 

These foods may cause heartburn or reflux

  • Whole milk, chocolate milk, milkshakes. 
  • Regular ice cream, chocolate pudding. 
  • Cream sauces. 
  • Regular cream soups (prepared with cream or whole milk) and tomato-based soups. 
  • Gravies, heavy cream, half and half, butter, margarine, oils, regular sour cream. 
  • Citrus fruits/juices (orange, lemon, pineapple, grapefruit, tangerine). 
  • Spearmint, peppermint, hot peppers, vinegar, mint teas. 
  • Acidic, salty, and extreme temperature (very cold or very hot) foods. 

Tips for avoiding gas and bloating

  • Foods which may cause gas and bloating: beans, broccoli, brussel sprouts, cauliflower, cabbage, corn, garlic, lentils, turnips, onions, scallions, peas, sauerkraut, soybeans, apples, avocados, watermelon, cantaloupe, honeydew melon, beer, and nuts. 
  • Avoid "air swallowing" activities, such as: using straws, slurping foods, chewing gum, sucking on candy or ice cubes, and drinking carbonated beverages. 

Dumping Syndrome 

Dumping syndrome is another possible concern after esophageal surgery. This happens when undigested food is "dumped" too quickly from the stomach into the small intestine. Symptoms such as nausea, feelings of fullness, and crampy abdominal pain are followed by diarrhea, usually within 15 minutes of a meal. Some individuals may also experience low blood sugar 1 to 2 hours after meals, which may cause weakness, nausea, sweating, hunger, fast heart rate, anxiety, and shaking. 

Please note that some of the suggestions for managing dumping syndrome conflict with recommendations provided for decreasing reflux and for ease of swallowing. Use the suggestions that help you feel the best. 

Tips to Avoid Dumping Syndrome 

  • Drink liquids 30 to 60 minutes before or after meals and limit it to ½ to 1-cup servings. Choose unsweetened liquids (100% fruit juice may be diluted). 
  • Drink six to eight 8-ounce glasses of non-caffeinated beverages daily. Carbonated beverages should be avoided initially, as they may cause gas and bloating. 
  • Eat small, frequent meals. If you experience discomfort after eating, decrease your portion sizes or number of foods eaten at one time. Try to eat three small meals and three between-meal snacks. The evening snack should be eaten 1 to 2 hours before bedtime. 
  • Relax at mealtimes, eat slowly and chew your food well. It may be helpful to lie down for 20-30 minutes following meals. 
  • All food and drink should be moderate in temperature. Avoid very cold or frozen foods, and very hot foods. 
  • Initially, you may experience lactose intolerance (the inability to digest milk sugar). Add small amounts of milk to determine tolerance. 
  • The diet should be moderate in fat (fat slows stomach emptying), high in protein, and low in simple carbohydrates (sugar, sweets). 
  • If your appetite is poor and weight loss occurs, a liquid supplement may be used. 
    • Examples include: Ensure®, Resource®, or Boost®, which contain sugar. 
    • If avoiding sugar or sweets, Diet Carnation Instant Breakfast® (which contains milk)
    • Resource Diabetic®, Choice® or Glucerna® are possible choices. 
  • Eat a variety of foods to assure adequate amounts of vitamins, minerals, calories and protein to meet your needs and prevent weight loss. A multivitamin is recommended. Ask your doctor if you require iron, vitamin B12 or folic acid supplementation after surgery. 
  • Avoid foods that are natural laxatives such as caffeine, figs, prunes or licorice. 

Sample Meal Plan

Breakfast 

Lunch 

Dinner 

½ Banana 

Cold/Hot Cereal (1/2 cup) 

1 Slice Toast 

Margarine (1 tsp) 

*Milk (1/2 cup) 

Hamburger patty (2 oz) 

Toasted hamburger bun 

Sliced tomato & lettuce 

Mayonnaise/Ketchup 

Applesauce (1/2 cup) 

*Milk (1/2 cup) 

*Tea (1/2 cup) 

Broiled Chicken (3 oz) 

Broccoli (1/2 cup) 

1 small baked potato 

Margarine (2 tsp) 

Fruit Cocktail (1/2 cup) 

*Tea/Coffee (1/2 cup) 

Midmorning Snack 

Afternoon Snack 

Bedtime Snack 

Cheese (1 ounce) 

Graham crackers (4) 

*Milk (1/2 cup) 

Turkey (1 ounce) 

Crackers (6) 

Mustard 

Vegetable Soup (1 cup) 

Peanut butter ( 2 Tbsp) 

Crackers (6) 

*Fruit Juice (1/2 cup) 


*If experiencing dumping syndrome, liquids should be given 30-60 minutes before or after the meal and limited to ½ to 1-cup servings. 

Food List 

This list contains general recommendations as to how well specific foods are tolerated by people after esophagectomy. 

 

Generally Well Tolerated 

Generally Not Tolerated 

Beverages 

Milk as tolerated, tea, unsweetened or diluted fruit drinks, water 

Alcohol, sweetened fruit drinks*, carbonated beverages*, coffee*, chocolate milk drinks and milkshakes* 

Breads & Cereals 

Unsweetened dry cereals, cooked cereals (oatmeal, farina, grits, cream of wheat, cream of rice) 

Well toasted breads and dense coarse breads/rolls may be tolerated 

Soft, breads, rolls, bagels, English muffins, thick-crust pizza, soft pretzels 

**Hard pretzels & corn chips may cause discomfort 

Desserts 

Sugar-free pudding or custard, sugar free gelatin, artificially sweetened frozen yogurt, ice cream, sherbet and ice milk, sugar-free popsicles 

All doughy baked desserts, all sweets and desserts made with sugar, dried fruits, or chocolate* 

Fats 

Butter, margarine, salad dressing, vegetable oils, sour cream, cream cheese 

Sweetened salad dressings* 

Fruits 

Unsweetened canned fruits and fruit juices, fresh fruits 

All dried fruits, sweetened fruit juice, fruits canned in light or heavy syrup* 

Citrus fruits* 

Meats & Meat Substitutes 

Ground or chopped meats, slow cooked tender meats (pot roast and stews), lean, tender meats, fish, poultry, shellfish, eggs, smooth peanut butter, cottage cheese, cheeses, tofu and soy products 

Tough, stringy, or grisly meats. 

Highly spiced or seasoned meats* 

Fried meats* 

Potatoes & Other Starches 

Potatoes, rice, barley, noodles, pasta 

Any to which sugar has been added* 

Soups 

Soups made with well cooked and tender meats 

Soups prepared with heavy cream or high fat ingredients* or tomato based* 

Sweets 

Sugar substitutes and sweets made with sugar substitutes 

Sugar*, syrup*, honey*, jelly*, jam*, molasses*, marshmallows* 

Vegetables 

Cooked fresh or frozen vegetables, canned vegetables or vegetable juices, raw vegetables as tolerated, small pieces may be easier to swallow 

Fried vegetables* 

Tomato sauces* 

Miscellaneous 

Salt, pepper, mildly flavored sauces and gravies, other seasonings as tolerated 

Hot peppers*, tomato products*, products made with mint*, acidic foods*, vinegars* 

*If no adverse symptoms occur, these foods can be added as tolerated.


News
Minimally Invasive Esophagectomy Offers Benefits

May 2, 2012 - Compared with open transthoracic esophagectomy, minimally invasive transthoracic esophagectomy is associated with significantly fewer pulmonary infections and with other short-term benefits in patients with resectable cancer of the esophagus, according to research published online May 1 in The Lancet.