1. Upper Gastrointestinal Disorders

2. Gastroesophageal Reflux Disease - GERD

3. Pathophysiology
GERD occurs when acidic gastric juices back flow into the esophagus through an incompetent lower esophageal sphincter (LES).

5. Symptoms of Gastroesophageal Reflux Disease (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.

6. 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 )

7. 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

8. Treatment of GERD - lifestyle modifications
Treatment of GERD - lifestyle modifications
Avoid large meals to avoid increased gastric pressure
Limit foods that weaken chocolate- high fat foods- peppermint)
Avoid smoking and alcohol
lower esophageal sphincter pressure or increase gastric acid secretion
( caffeine- garlic- onion-

9. 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.

10. 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

11. Avoid wearing tight clothing that increases pressure in the stomach
Lose weight if needed because weight loss decreases intra-abdominal pressure
Avoid use of non-steroidal anti inflammatory drugs (NSAIDS)

12. Treatment of GERD
Drugs that suppresses acid secretion by inhibiting receptors on acid-producing cells.
Antacids
Surgery

13. Hiatal Hernia

14. Hiatal Hernia
Part of stomach protrudes through diaphragm into thoracic cavity
Prevents food from moving normally along digestive tract
Heartburn and food regurgitation into mouth can occur
(continues) 14

16. Medical nutrition therapy of Hiatal Hernia
Small, frequent meals of well-balanced diet
Avoid irritants to esophagus
Avoid foods that relax lower esophageal sphincter
Weight loss recommended if necessary
Avoid lying down two to three hours after eating 16

17. Conditions Affecting the Stomach

18. Dyspepsia

19. Symptoms dyspepsia Indigestion in the upper abdominal area
Symptoms may include :
Stomach pain
Heartburn
Fullness
Nausea
Bloating

20. 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

21. Dyspepsia 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

22. If the problem is organic in origin, treatment of the underlying cause will be the normal procedure.

23. Dyspepsia Bloating and stomach gas Chewing gum Smoking
Rapid eating, drinking carbonated beverages
Omitting these practices generally helps to correct the problem.

24. Peptic Ulcer

25. 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 resistance to, hydrochloric acid.

26. 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

27. 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

28. Other causes genetic predisposition
abnormally high secretion of hydrochloric acid by the stomach

29. 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

30. Complications of Peptic Ulcer
GI bleeding
(black stool- vomit that resembles coffee ground)
Perforations of the stomach or duodenum leading directly into the peritoneal cavity
Gastric outlet obstruction due to inflammation

31. Drug therapy for Peptic Ulcer
Drugs that suppresses acid secretion by inhibiting receptors on acid-producing cells
Antacids
Coating agents
Antibiotics to eradicate H.pylori

32. 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.

33. 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.

34. 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.