♦ Delays the passage of food into the small intestine.

♦ May prevent or slow the absorption of medication.

♦ Causes early satiety, loss of appetite, inability to finish meals.

♦ Can cause gastro-oesophageal reflux disease: O May lead to injury of oesophagus and lower oesophageal sphincter. O Can cause Barrett's oesophagus, a precancer-

ous condition. O If dysphagia is present, there is increased risk for aspiration of refluxed stomach contents, and aspiration pneumonia. O Medications used to treat gastro-oesophageal reflux disease by raising gastric pH can interfere with the metabolism of some nutrients, including vitamin B12 and iron.

♦ Management. Numerous small meals and snacks, nutrient-dense and moderate in fat and fibre, are preferred. Protein needs should be assessed, and should be divided equally among small morning, midday, and evening meals, levodopa taken about 30 minutes before these. Low-protein snacks should be taken between these meals to meet total calorie needs. Use of 'liquid Sinemet' or Parcopa (USA) or Madopar Dispersible (Europe) may be helpful when stomach emptying is slowed.

O If gastro-oesophageal reflux disease is present, use of small meals and avoidance of 'trigger foods,' i.e. caffeine, citrus, tomatoes, alcohol, should be helpful. The day's final meal should be consumed at least 4 hr before bedtime, so that the stomach is empty before lying down.

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