After surgery you will need to follow a strict diet because all or part of the esophagus is removed. Your diet will slowly change as you heal. The diet is to help make you more comfortable as you to eat.
The stomach is made into a tube and is pulled up into the chest to replace the part of the esophagus that was 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.
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
Nutrition is very important after surgery. Calories provide the building blocks you need to heal. Most patients who have this surgery will have a feeding tube put in. This will help you get extra nutrition until you can go back to your regular diet. This tube is called a jejunostomy tube or J-tube. The tube is put in through the belly and into a part of your small intestine. Your doctor can give you liquid nutrition (tube feedings) through the J-tube until you can eat enough food by mouth.
Continuous Feeding
You will start tube feedings in the hospital a few days after surgery. We often start tube feedings at a low, continuous rate. If you tolerate the feeds, with no severe cramping, nausea, or vomiting, we increase the rate to provide more calories.
Cycled Feedings
As the rate increases, we may change you to cycled tube feedings. This means for some of the day the feedings will be shut off. Cycled feedings most often run from 6 pm to 12 pm (18 hours), giving you 6 hours during the day that you don’t need to be attached to the feeding pump. We may change the tube feeding rate to a 12-hour cycled feeding later on.
You will follow this feeding plan until your doctor believes you can eat enough nutrition to maintain your weight and heal. You will likely still have tube feedings when you go home after discharge. Depending on your progress, the J-tube may be removed in the clinic at a future date.
What to Expect with Tube Feedings
Expect some cramping when the tube feedings start. The cramping is often brief and stops within a few days. There may also be some loose stools. This may be from the tube feedings or medicines. If you are having a lot of, or uncomfortable, loose stools, we may change the type or rate of your tube feeding to help.
Tips for Common Eating Problems After Surgery
Feeling Full After Eating
After surgery you will have a smaller stomach. Eat 6 to 8 small meals per day.
Take small bites and chew your food fully.
Limit fluids to ½ cup (4 ounces) with meals and 1 cup (8 ounces) with snacks. This will help with fullness and dumping/diarrhea.
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 swallow and digest.
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, tell your surgeon.
Sit straight up when you eat. Gravity can help move food down. Keep sitting up 30 to 60 minutes after you eat. This will help with acid reflux also.
Dumping
Dumping syndrome is 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 1 cup (8 ounces) with snacks. This will help with fullness and dumping.
Limit sweets to the end of the meal. Sweets are digested more quickly than other foods. Eating sweets first can also lead to low blood sugar.
Avoid very cold or very hot foods
Types of Diets
Each person tolerates food in different ways and heals at different rates. Your doctor will change your diet based on your progress.
The 3 diets that you will be on:
Esophageal Clear Liquid Diet
Esophageal Full Liquid Diet
Esophageal Soft Diet
Esophageal Clear Liquid Diet
This will be your first diet after surgery. To be a clear liquid, you must be able to see through it (no pulp or cloudiness). You may have:
Water
Clear juice (apple, cranberry, grape)
Clear broth (chicken, beef, vegetable)
Gelatin (such as Jell-O®)
Popsicles
Tea (decaf to avoid reflux)
Carbonated drinks are not allowed because they may cause gas.
Esophageal Full Liquid Diet
A full liquid diet includes anything that is liquid at room temperature. It is a liquid if the food item would be able to go through a kitchen strainer. Along with the liquids in a clear liquid diet you may also have:
Yogurt (without pieces of fruit or seeds)
Cream of wheat or cream of rice hot cereal
Pureed soups
Ice cream, frozen yogurt, sherbet, sorbet
Milk and milkshakes
Pudding
Liquid nutritional supplements like Ensure®, Carnation Breakfast Essentials® 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®.
Full Liquid Diet Sample Menu
Breakfast
Apple juice (4 ounces)
Cream of wheat cereal made with milk or Lactaid®
Snack
Carnation Instant Breakfast® Drink (4 ounces)
Lunch
Pureed soup (strained), not tomato or broccoli
Cranberry juice
Snack
Boost® nutritional supplement (4 ounces)
Dinner
Pureed soup (strained) not tomato or broccoli
Vanilla pudding
Snack
Sherbet
Esophageal Soft Diet
This diet should consist of bland, soft foods. Cut up tough meats into tiny pieces and add sauces or gravies to foods.
Breads/Grains
Choose:
French toast
Crackers
Toasted bread
Avoid:
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
Choose:
Hot cereal: Oatmeal, cream of wheat, cream of rice
Cold cereals: Cheerios, Honey Nut Cheerios, Rice Chex, Corn Flakes, Rice Krispies
Avoid
Coarse cereals such as Grape Nuts® and granola
Any cereals with fresh or dried fruit, seeds, or nuts
Drinks
Choose:
Regular milk
De-caffeinated tea
Powdered drink mixes
Non-citrus juices such as apple, cranberry, grape, and blends
Avoid
Chocolate milk
Soda (carbonated drinks)
Alcoholic drinks
Citrus juices such as orange juice, grapefruit juice, lemon and lime
Drinks that contain herbal ingredients such as St John’s Wort or ginseng
Drinks with caffeine: coffee, tea, decaf coffee
Meat and Alternatives
Choose:
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
Avoid
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
Choose:
Peeled white or sweet potatoes
White Rice and barley
Pasta such as enriched noodles, spaghetti, and macaroni.
Avoid:
Fried potatoes, potato skins
Fried, brown, or wild rice
Popcorn
Fruits
Choose:
Canned fruit
Cooked fruit (no skins)
Fruit juice, except citrus
Avoid:
Fresh or dried fruit
Citrus fruits and juices (orange, grapefruit, lemon, lime)
Vegetables
Choose:
Cooked vegetables without seeds or skins, such as asparagus tips, baby peas, carrots, green beans, and winter squash.
Avoid:
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
Choose:
Mildly flavored meat stock
Creamed soups made with allowed ingredients
Avoid:
Highly seasoned soups and tomato-based soups
Desserts
Choose:
Plain cakes, cookies, puddings, custard, ice cream, ice milk, frozen yogurt, and sherbet.
Gelatins, popsicles
Avoid:
Desserts that contain chocolate, coconut, nuts, seeds, fresh or dried fruit, peppermint, or spearmint
Sweets
Eat small amounts and with a meal. Note: If you have dumping, avoid these.
Choose:
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.
Avoid:
Jam and marmalade, preserves made with seeds or fruit
Chocolate sweets/candy
Desserts that contain chocolate, nuts, coconut, seeds, peppermint, or spearmint
Dried or fresh fruit
Esophageal Soft Diet Sample Menu
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 before your surgery. In most cases, once the doctor says that you may go back to a normal diet, you will want to add one new food item each day and see how you tolerate the food before adding another food.
Who to Call
If you are a UW Health patient and have more questions, please contact UW Health at the phone number 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.