🍎Medical Nutrition Therapy I Unit 4 – GI Disorders: Upper Tract

Overview of Upper GI Tract

• Consists of the mouth, pharynx, esophagus, stomach, and duodenum (first part of the small intestine)
• Plays a crucial role in the digestion and absorption of nutrients from food
• Mechanical and chemical breakdown of food begins in the mouth through chewing and the action of salivary enzymes
• Esophagus transports food from the mouth to the stomach via peristaltic contractions
• Stomach secretes hydrochloric acid and digestive enzymes (pepsin) to further break down food
  • Also acts as a temporary storage site for ingested food
• Duodenum receives partially digested food (chyme) from the stomach and continues the digestive process
  • Receives digestive secretions from the pancreas and liver (bile) to aid in digestion and absorption

Common Upper GI Disorders

• Gastroesophageal reflux disease (GERD): chronic backflow of stomach acid into the esophagus causing irritation and inflammation
• Peptic ulcers: open sores that develop in the lining of the stomach or duodenum, often caused by Helicobacter pylori (H. pylori) infection or long-term use of nonsteroidal anti-inflammatory drugs (NSAIDs)
• Gastritis: inflammation of the stomach lining, which can be acute or chronic
• Dyspepsia: persistent or recurrent pain or discomfort in the upper abdomen, often related to meals
• Esophageal disorders such as achalasia (impaired relaxation of the lower esophageal sphincter) and eosinophilic esophagitis (allergic inflammation of the esophagus)
• Gastroparesis: delayed gastric emptying, often associated with diabetes or post-surgical complications
• Hiatal hernia: protrusion of the stomach through the diaphragm into the chest cavity

Symptoms and Diagnosis

• Common symptoms of upper GI disorders include heartburn, acid reflux, abdominal pain, bloating, nausea, vomiting, and dysphagia (difficulty swallowing)
• Diagnosis often involves a combination of patient history, physical examination, and diagnostic tests
• Endoscopy allows direct visualization of the upper GI tract and can help identify structural abnormalities, inflammation, or ulcers
  • Biopsy samples may be taken during endoscopy for further analysis
• Barium swallow or upper GI series uses X-rays to visualize the esophagus, stomach, and duodenum after the patient drinks a barium contrast solution
• Esophageal manometry measures the pressure and motility of the esophagus to diagnose disorders like achalasia
• pH monitoring can detect abnormal acid exposure in the esophagus, helpful in diagnosing GERD
• Breath tests (urea breath test) can detect the presence of H. pylori infection

Nutritional Implications

• Upper GI disorders can lead to malnutrition due to impaired digestion, absorption, or intake of nutrients
• GERD and esophageal disorders may cause difficulty swallowing or pain, leading to reduced food intake and weight loss
• Peptic ulcers can cause blood loss, leading to iron-deficiency anemia
• Gastritis and dyspepsia may cause reduced appetite and food avoidance, affecting overall nutrient intake
• Gastroparesis can lead to poor nutrient absorption due to delayed gastric emptying and bacterial overgrowth
• Malabsorption of specific nutrients (iron, calcium, vitamin B12) may occur due to impaired stomach acid secretion or intestinal damage
• Nutritional deficiencies can further exacerbate symptoms and impair healing of the GI tract

Medical Management

• Treatment of upper GI disorders depends on the specific condition and its severity
• Proton pump inhibitors (PPIs) and H2 receptor antagonists (H2RAs) reduce stomach acid production and are used to treat GERD, peptic ulcers, and gastritis
• Antibiotics (clarithromycin, amoxicillin) are prescribed to eradicate H. pylori infection in peptic ulcers
• Prokinetic agents (metoclopramide) can improve gastric emptying in gastroparesis
• Endoscopic procedures may be necessary to treat certain conditions, such as dilation for achalasia or removal of foreign bodies
• Surgery may be required in severe cases or when complications arise (fundoplication for GERD, pyloroplasty for gastroparesis)
• Pain management with antispasmodics or low-dose antidepressants may be necessary for functional disorders like dyspepsia

Dietary Interventions

• Dietary modifications play a crucial role in managing upper GI disorders and alleviating symptoms
• For GERD, patients should avoid trigger foods (spicy, acidic, or high-fat foods), eat smaller, more frequent meals, and avoid eating close to bedtime
• A low-fiber diet may be recommended for peptic ulcers to reduce irritation and promote healing
• Gastroparesis patients may benefit from a low-fat, low-fiber diet with smaller, more frequent meals to facilitate gastric emptying
  • Liquid or pureed foods may be better tolerated in severe cases
• Dyspepsia patients should identify and avoid trigger foods, eat slowly, and chew thoroughly
• Nutrient-dense foods should be encouraged to prevent or correct nutritional deficiencies
• Adequate hydration is important to maintain GI function and prevent constipation
• Enteral nutrition (tube feeding) may be necessary for patients with severe malnutrition or inability to consume adequate nutrients orally

Lifestyle Modifications

• In addition to dietary changes, lifestyle modifications can help manage upper GI disorders
• Weight loss, if overweight or obese, can reduce symptoms of GERD and dyspepsia
• Elevating the head of the bed (6-8 inches) can reduce nighttime reflux symptoms in GERD
• Quitting smoking is essential, as it can exacerbate GERD, peptic ulcers, and other upper GI disorders
• Stress management techniques (relaxation, meditation, cognitive-behavioral therapy) can help reduce symptoms of functional disorders like dyspepsia
• Regular exercise can promote overall GI health and motility, but should be avoided immediately after meals in GERD patients
• Avoiding tight clothing around the waist can reduce pressure on the stomach and lower esophageal sphincter
• Maintaining good posture and avoiding lying down immediately after meals can prevent reflux episodes

Key Takeaways and Clinical Pearls

• Upper GI disorders are common and can significantly impact a patient's quality of life and nutritional status
• A thorough patient history and physical examination are essential for accurate diagnosis and treatment planning
• Endoscopy is a valuable tool for visualizing the upper GI tract and identifying structural abnormalities or pathology
• Nutritional assessment and intervention are crucial components of managing upper GI disorders to prevent or correct deficiencies
• Proton pump inhibitors (PPIs) are the mainstay of treatment for acid-related disorders like GERD and peptic ulcers
• Eradication of H. pylori infection is essential for the long-term management of peptic ulcers
• Dietary modifications, such as avoiding trigger foods and eating smaller, more frequent meals, can significantly improve symptoms
• Lifestyle changes, including weight loss, smoking cessation, and stress management, are important adjuncts to medical and nutritional therapy
• A multidisciplinary approach involving gastroenterologists, registered dietitians, and other healthcare professionals is often necessary for optimal patient care and outcomes