Upper Gastrointestinal Disorders
1-Gastroesophageal Reflux Disease- GERD
 GERD occurs when acidic gastric juices back flow into the
esophagus through an incompetent lower esophageal
sphincter (LES).
Symptoms of GERD
 Hearburn – most common GI complaint
 Reflux of small amounts of stomach acid into the mouth
 pain may radiate to the neck and throat
With GERD – gastric reflux causes sometimes, tissue
damage.
Causes of GERD
 Weakening or inappropriate relaxation of lower esophageal
sphincter
 Associated with pregnancy due to the elevation of
progesterone which esophageal sphincter
 Associated with hiatal hernia
 (a condition in which the upper portion of the stomach
protrudes above the diaphragm )
Consequences of GERD
 Reflux esophagitis
 (inflammation in the esophagus related to the reflux of
acidic stomach contents).
 Esophageal ulcers
 Scarring of ulcerated tissue
 increased risk of cancer
Treatment of GERD - lifestyle modifications
 Avoid large meals to avoid increased gastric pressure
 Limit foods that weaken chocolate- high fat foodspeppermint)
 Avoid smoking and alcohol
 lower esophageal sphincter pressure or increase gastric acid
secretion ( caffeine- garlic- onion-chocolate- high fat foods –
peppermint)
 During times of esophagitis, avoid items that may irritate the
esophagus such as carbonated beverages, citrus fruits and
juices, spicy foods, tomato products, and any other
individual intolerances.
 People who avoid citrus juices and tomato products because
of their acidity should be encouraged to eat other sources of
vitamin C.
 Avoid eating bedtime snacks or lying down immediately
after meals Remain upright for 45 to 60 minutes after eating
 Consume meals 2-3 hours before bedtime
 Prop pillows under the head and upper torso during sleeping
 Avoid wearing tight clothing that increases pressure in the
stomach
 Lose weight if needed because weight loss decreases intraabdominal pressure
 Avoid use of non-steroidal anti inflammatory drugs (NSAIDS)
Treatment of GERD
• Drugs that suppresses acid secretion by inhibiting receptors
on acid-producing cells.-Antacids-Surgery
2-Hiatal Hernia
1. Part of stomach protrudes through diaphragm into thoracic
cavity
2. Prevents food from moving normally along digestive tract
3. Heartburn and food regurgitation into mouth can occur
Medical nutrition therapy of Hiatal Hernia
4.
5.
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7.
Small, frequent meals of well-balanced diet
Avoid irritants to esophagus
Avoid foods that relax lower esophageal sphincter
Weight loss recommended if necessary
8. Avoid lying down two to three hours after eating
Conditions Affecting the Stomach
3- Dyspepsia
Symptoms dyspepsia
Indigestion in the upper abdominal area
Symptoms may include :
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Stomach pain
Heartburn
Fullness
Nausea
Bloating
Causes of dyspepsia
• Medical conditions : peptic ulcers, GERD, motility disorders,
malabsorptive disorders,gallbladder disease, abdominal
tumors, diabetes mellitus, renal disease, thyroid disease,
heart failure
• Medications
• Dietary supplements
Potential food intolerances
• Overeating
• Specific foods – spicy
• Coffee including decaffeinated
• High-fat foods
• Advised to consume small meals, well-cooked foods - not
overly seasoned, in a relaxed atmosphere
If the problem is organic in origin, treatment of the underlying
cause will be the normal procedure.
Bloating and stomach gas
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Chewing gum
Smoking
Rapid eating, drinking carbonated beverages
Omitting these practices generally helps to correct the
problem.
Peptic Ulcer
Erosion of the mucosal layer of the stomach (gastric ulcer) or
duodenum (duodenal ulcer) caused by an excess secretion of, or
decreased mucosal resis tance to, hydrochloric acid.
Primary cause
• Helicobacter pylori infection is the primary factor of the
disease and was found in 60% of Gastric ulcers patients and
in 80% of Duodenal ulcers patients
• Another major factors is the use of certain drugs like aspirin
which can damage mucosal tissue
• Emotional stress
Other causes for peptic ulcer
• genetic predisposition
•
abnormally high secretion of hydrochloric acid by the
stomach
Effects of emotional stress:
Has effects on physiological processes
• Rapid stomach emptying which increase the acid
load in the duodenum)
• Hormonal changes that impair wound healing
• Increased acid and pepsin secretions
Has behavioral changes
• Use of alcohol
• Tobacco use
• NSAID use
Signs and symptoms of Peptic Ulcer
• Peptic ulcer symptoms vary. Ulcer pain may be
experienced as a :
 Hunger pain
 Burning pain in stomach region
 Sometimes aggravated by food
 causes loss of appetite and weight loss
Complications of Peptic Ulcer
1-GI bleeding(black stool- vomit that resembles coffee ground)
2-Perforations of the stomach or duodenum leading directly into
the peritoneal cavity
3-Gastric outlet obstruction due to inflammation
Drug therapy for Peptic Ulcer
1. Drugs that suppresses acid secretion by inhibiting
receptors on acid-producing cells
2. Antacids
3. Coating agents
4. Antibiotics to eradicate H.pylori
Dietary considerations for peptic ulcer
 Individualized to personal tolerances
 Avoid foods that increase acid secretion or irritate the
GI lining – alcohol, coffee, caffeine, spicy foods,
carbonated beverages, chocolate.
 Avoid large meals that cause stomach distension
 Avoid lying down two to three hours after eating
 No smoking ( it delay the healing)
 Good chewing of food. Sufficient low-fat protein
should be provided but not in excess because of its
ability to stimulate gastric acid secretion.
 It is recommended that clients receive no less than 0.8
gram of protein per kilogram of body weight.
 However, if there has been blood loss, protein may be
increased to 1 or 1.5 grams per kilogram of body
weight
 Although fat inhibits gastric secretions, because of the
danger of atherosclerosis, the amount of fat in the diet
should not be excessive.
 Carbohydrates have little effect on gastric acid
secretion.
 Vitamin and mineral supplements, especially iron if
there has been hemorrhage, may be prescribed.