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 and for a meal plan immediately after surgery.

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
Take small bites and chew food well
After surgery, you may have decreased stomach capacity and less tolerance to certain foods
If a food causes you discomfort, wait a week or two then retry the food
Try eating 6 small, high-calorie, high-protein meals and snacks throughout the day, rather than 3 larger meals.
Drink 6-8 eight-ounce glasses of fluids daily
Stop eating when you start to feel full
Take a daily multivitamin. A chewable multivitamin is usually well tolerated. Take either one adult or 2 children’s chewable vitamins. A calcium supplement may be indicated – ask your surgeon.

Tips to avoid heartburn or reflux

Avoid tight-fitting clothing and frequent bending
Elevate bed to 6 inches when sleeping
Limit caffeine intake (coffee, tea, and cola drinks).
Limit fatty foods
Avoid chocolate
Avoid acidic foods (tomatoes, vinegar, hot peppers, and citrus fruits)
Avoid spearmint and peppermint
Avoid carbonated beverages
Limit or avoid alcohol
Avoid eating both extremely hot or cold foods
Sit upright after eating and remain in a sitting position for 45-60 minutes after eating
Do not eat for 2 hours before bedtime

Tips for avoiding gas and bloating

Foods which may cause gas and bloating: beans, broccoli, Brussels 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: using straws, slurping foods, chewing gum, 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 manage your symptoms.

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 2 hours before bedtime.
Relax at mealtimes, eat slowly and chew your food well.
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). Try 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® or Boost®, which contain sugar.
- If avoiding sugar or sweets, Diet Carnation Instant Breakfast® (which contains milk), Boost Glucose Control® or Glucerna®
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 calcium, iron, vitamin B12, or folic acid supplements after surgery.
Avoid foods that are natural laxatives such as caffeine, prunes, and other dried fruits

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.