Dietary advice for patients with an oesophageal tube

A tube (stent) has been inserted into your oesophagus to help with your swallowing. The oesophageal stent is usually made of a metal mesh. The length of the stent depends on the length of the stricture or narrowing in your oesophagus and is usually 9-12mm (about ¼ - ½ inch) wide. They are held in position by the narrowing stricture and opens up to make your oesophagus wider to allow food and drink to pass from your mouth to your stomach. You should now be able to take ‘easy to chew foods and manage a more varied diet, without feeling that food is getting stuck.

Once fully expanded, the stent cannot stretch, so it is important for you to avoid chunky and sticky foods that may block it.

It is advisable that you discuss your new diet with your Dietitian. You can arrange a referral through your Doctor if you have not already seen one.

Advice for when you start eating

After the stent is inserted, you may initially feel a little bit nervous about starting to eat again. Don’t worry, as these feelings are normal. Your confidence will improve in time. Here are some tips to help you

• Eat ‘little and often’ - five to six times a day rather than trying to have big meals
• Eat slowly. Don’t rush to keep up with others, eat meals at your own speed. It is best to try to sit upright at a table to eat as it will help the food go down
• Take small mouthfuls of food
• Chew your food well before swallowing. It is very important to chew your food thoroughly to make sure that you do not swallow any lumps of food that may block the stent. If you wear dentures, make sure that they fit properly.
• Take sips of drink during and after meals. Warm or fizzy drinks such as lemonade, Coca-Cola, ginger ale, and tonic water will help to keep the tube clean and prevent food particles from sticking. Be careful with fizzy/ gassy drinks if you are prone to reflux as this may make your symptoms worse.
• Tablets can be broken down or crushed and taken with fluid. Check with your doctor or pharmacist first, as it may affect the way they are released into your system. Some medication may also be available as a suspension to make swallowing easier.

When to start eating and drinking

Day of procedure

• Take clear fluids only. For example: water, fruit cordials, black tea/coffee, apple or cranberry juice, Bovril/clear soup, FortiJUCE supplements

Day 1 after procedure

• All types of fluids are allowed e.g. milky coffee, hot chocolate. If you have been managing fluids and swallowing well, try soften easy to chew and moist diet. For example: soup, scrambled egg, steamed fish in sauce, yoghurt, mashed banana, biscuits dipped in a drink, soft omelette, shepherd’s pie with gravy, fish cakes with sauce, custard, ice cream.

Day 2 after procedure

• If you have been managing an easy to chew diet, try more solid foods. These foods could include: soft bread (avoid freshly baked bread and cut the crusts off), soft vegetables, baked beans, pasta, soft cake, rice pudding

Day 3 Onwards

• Expand foods to eat a more normal diet. If you have any problems with more solid foods, continue with an easy to chew diet until you feel able to slowly introduce more solid food.

Remember to eat a variety of foods to maintain a balanced diet

What shall I do if I think the stent is blocked?

• Don’t panic
• Stop eating
• Have a few sips of a warm or fizzy drink
• Walk around If the blockage persists for more than 3 hours, contact your GP or Specialist Nurse because you may need to be admitted to remove the blockage endoscopically.

What consistency of food should I eat?

• You should be able to eat solid foods of an easy to chew consistency. You are advised to chew your food well. If you are still experiencing difficulty with chewing or swallowing, it may be advisable to try liquidising your meals, you can discuss this with your dietitian.
• Where possible try to have a wide variety of foods in your diet to ensure adequate nutrition.

Menu plan for easy to chew choices

• It is important to try to eat regularly – small, frequent meals are best.
• Have regular sips of warm or fizzy drinks during and after meals.
• Full fat and sugar products should be used, for example full cream milk, creamy yoghurts where your appetite is low.

Breakfast:

• Porridge, Ready Brek, Weetabix, Cornflakes made with fortified milk and sugar or honey
• Scrambled eggs made with milk and butter/margarine
• Soft fruit, for example banana, stewed apple, pear, melon
• Glass of fruit juice

Mid-morning:

• Milky drink (ideally make with fortified milk)
• Snack, for example soft biscuits, cake, creamy yoghurt

Lunch:

• Tender meat in gravy, shepherd’s pie, chicken stew
• Fish in sauce, for example parsley or butter sauce
• Mashed potato with added butter, cream, cheese
• Well-cooked vegetables, for example carrots, cauliflower with butter, cheese, sauce

If you feel full up after your main course, you may prefer to leave your sweet until later:

• Milk pudding, for example ground rice pudding
• Sponge pudding and cream, ice cream, custard

Mid-afternoon:

• As for mid-morning

Evening Meal:

• Jacket potato (inside only) with butter and soft filling, for example tuna with mayonnaise or tinned spaghetti
• Soup with added cream, cheese, or tender meat
• Bread (best if not fresh) and butter/margarine with cream cheese, pate, or meat paste
• Omelette with cheese
• Yoghurt, ice cream
• Trifle, whip, mousse

Supper:

• Warm milky drink, for example hot chocolate, Horlicks, Ovaltine
• Biscuits (soften by dunking in a warm drink) or soft cake
• Cereal with fortified milk and sugar or honey

What shall I do if...

I have heartburn and indigestion:

• Eat small meals, ‘little and often’ – five to six times a day rather than trying to have big meals.
• Sit upright to eat and try not to bend down or rush around until your meal has settled.
• Take small mouthfuls of food, eat slowly and chew food well.
• Avoid tight fitting belts and clothing.
• To prevent acid from your stomach coming back into your gullet, sleep in a semi-upright position. This is best achieved by placing blocks (15cm) under the legs at the head of the bed so that the bed is at an angle of 45 degrees in addition to sleeping propped up on three to four pillows. It is also advisable to try not to eat too late at night, for example 2 hours before you go to bed.

If your symptoms persist, discuss this with your doctor. You should already be prescribed an anti-acid medication.

I have a poor appetite and am losing weight:

• Try to eat small and frequent meals and snacks, for example every two hours.
• Be positive about what you do eat – every extra mouthful helps.
• Try not to get out of the habit of eating. You actually need to eat to stimulate your appetite.
• Your appetite may come and go, so it is important to make the most of the times when you feel like eating.
• Don’t worry if it isn’t ‘normal’ foods at ‘normal’ times – if you fancy cereal at midnight, enjoy it!
• Try to relax and enjoy what you eat. Eat slowly and chew your food well, trying to rest before and afterwards.
• A short walk before a meal or some fresh air may help give you an appetite.
• A small glass of wine, beer, sherry or your favourite drink taken half an hour before a meal may boost your appetite. Check with your doctor first.
• Experiment with different foods. You may find that you like things you don’t usually eat.
• Try to make your food and drinks as nourishing as possible (see the food fortification section for tips.)
• Don’t worry if you don’t feel like cooking, cold meals can be as nutritious as hot ones (see the quick and easy meals sheet for ideas.)
• Accept offers from friends and relatives to help with cooking and shopping.
• Convenience foods are a useful standby and can be just as nourishing.
• If you have a freezer, try to prepare food in advance when you feel like cooking and store it for when you are not feeling so well.
• Avoid filling yourself up with large servings of vegetables, salads, and water. They provide bulk but little nourishment.
• Tempt your appetite by making food look attractive – use small portions on a small plate, and try adding garnishes such as lemon or parsley.
• Sometimes the smell of food will be appetising; at other times it may put you off. If this happens, try to keep away from the kitchen while food is being prepared, or eat cold foods, which often have less smell.

Food Fortification

If you are only eating small portions the following tips may help you to get more calories without necessarily having to eat more food. Start by buying full fat foods. Avoid “light” or “diet” versions of foods. These are not appropriate for you at the moment.

Milk: Add 2oz (4 tablespoons) of milk powder such as Marvel or “Five Pints‟ to 1 pint of full cream milk. This can be used in the usual way in drinks, on cereals, in sauces and puddings.

To savoury foods add cheese, fortified milk, gravy, milk powder, pulses, meat, cream, crème fraîche, pesto or butter/margarine (not low fat spread).

For example:

• Add beans or pulses to soups and casseroles.
• Cheese on mashed potato with milk, milk powder and butter/margarine/olive oil.
• Butter, cheese or white sauce on vegetables.
• Add 2 tablespoons of milk powder to a portion of white sauce.
• Add grated cheese/cream/milk or crème fraîche to soup.
• Add cream/sour cream or crème fraîche to casseroles.
• Add mayonnaise/ salad cream or pesto to sandwiches or have two fillings, such as: egg mayonnaise and bacon or cheese and ham.

To sweet foods add fortified milk, sugar, cream, honey, syrup, ice cream or evaporated milk.

For example:

• Cream/custard/ice cream/evaporated milk with pies, sponge or fruit
• Add extra sugar, honey or syrup to desserts and cereals
• Make jelly with fortified milk, instead of water
• Add 2 tablespoons of milk powder to a portion of porridge, milk puddings and custard
• Add cream, yoghurt, sugar, honey, evaporated milk to breakfast cereals

Nutritional supplement drinks:

Can be used to supplement your intake and help to maintain your weight. You can buy Complan or Meritene (Build up) in your chemist or supermarket. There is also a wide range of nutritional supplements available on prescription. If you continue to lose weight or are still experiencing difficulty with your nutritional intake contact your dietician or Specialist Nurse for a nutritional assessment and more specialist advice.

I feel full up or bloated:

• Eat small, frequent meals with snacks in-between.
• Try having your dessert half an hour after your main course.
• Try not to have drinks just before a meal as they are likely to fill you up.

Things to try:

• Biscuits
• Salty foods, for example crisps, savoury biscuits (unless your mouth is sore). These foods need to be chewed thoroughly before swallowing
• Scone or teacake
• Sandwiches with a plain filling, for example lean meat
• Ginger foods, for example ginger biscuits, cake
• Ice cream, fruit sorbets, jelly, milk puddings
• Light meal, for example plain poultry, meat or fish with mashed potato

Tips:

• Eat slowly and relax afterwards, but avoid lying flat

I feel sick:

Don’t force yourself to eat when you feel sick. It is important to keep your fluid intake up to prevent dehydration.

• Clear, cold drinks may be better tolerated
• Try sipping fizzy drinks such as soda water, ginger beer or lemonade
• Sip these slowly, using a straw may help
• Solid fluids such as sorbet or jelly may be easier to manage
• Herbal, ginger or peppermint tea may soothe an upset stomach

Practical hints:

• Nausea may become worse when the stomach is empty so try to take regular snacks. Start with small frequent meals and snacks and build up to your more normal diet as the sickness subsides.
• If possible, a short walk in the fresh air before eating may help. Fresh air also helps to stimulate your appetite.
• Avoid wearing tight fitting clothes.
• Some people find that highly spiced or rich or fatty foods make them worse - avoid them if they do.
• If the smell of cooking makes you feel nauseous you could try eating cold foods such as sandwiches, chilled desserts, for example yoghurts and mousses. Let a friend or relative cook if they offer.
• Try to relax and eat slowly in a well-ventilated room.

Your doctor can provide anti-sickness (anti-emetic) tablets if your symptoms persist. Ensure that you take them as prescribed. They help with symptoms of nausea as well as vomiting.

Contacts:

The Oesophageal Patients Association

The Oesophageal Patients Association was founded to provide support and reassurance to patients with oesophageal disease. All members are patients, and many have had an oesophageal tube inserted. Contact details are outlined below:

Telephone: 0121 704 9860

Friendly fully trained staff are available Monday to Friday 9 am - 5 pm. (24 hour answering machine)

Email us with enquiries

Address:

OPA
6 & 7
Umberslade Business Centre
Pound House Lane
Hockley Heath
Solihull
B94 5DF

Macmillan Cancer Support

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Call us free * on 0808 808 00 00 (Monday to Friday, 9am–8pm).

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