Upper Gastrointestinal

What structures are included in the upper GI tract?

Mouth, pharynx, esophagus, stomach, and duodenum.

What marks the division between the upper and lower GI tract?

The duodenojejunal junction, which is marked by the ligament of Treitz.

What is considered an upper GI bleed?

Bleeding that occurs above the duodenojejunal junction or ligament of Treitz.

What does an EGD examine?

An esophagogastroduodenoscopy examines the esophagus, stomach, and duodenum.

What is an upper GI series?

A medical imaging test that uses X-rays and fluoroscopy (real-time moving X-rays) to examine the structure and function of your upper digestive tract

A barium imaging study is used to examine the esophagus, stomach, and duodenum.

What does esophageal manometry evaluate?

It evaluates pressure and muscle function of the esophagus and its sphincters.

What is the purpose of a pH probe or Bravo capsule?

To measure esophageal acid exposure and help evaluate reflux.

What is a gastric emptying study (GES) used for?

To determine how quickly food leaves the stomach and help diagnose delayed gastric emptying.

What is the main function of the mouth in digestion?

Chewing food and mixing it with saliva to begin digestion and prepare food for swallowing.

What is the main function of the esophagus?

It transports food from the pharynx to the stomach through peristalsis. (muscular tube)

What are major functions of the stomach?

Mechanical mixing, acid and enzyme digestion (pepsin), and controlled release of chyme into the small intestine.

What occurs in the duodenum?

Further digestion and nutrient absorption begin with assistance from bile and pancreatic enzymes.

While the stomach acts as a blender to physically break down food, the duodenum is the "chemical laboratory" where food is actually neutralized and broken down into nutrients your body can absorb

How much saliva is normally produced each day?

Approximately 1–2 liters per day.

What are the major functions of saliva?

Lubricates food, begins carbohydrate digestion, provides antibacterial protection, and helps with taste.

Which enzyme begins carbohydrate digestion in the mouth?

Salivary amylase, also called ptyalin.

Why is oral health important for nutrition status?

Problems with the teeth, tongue, dentures, or mouth can interfere with chewing, swallowing, and adequate food intake.

What is xerostomia?

Decreased saliva production that results in dry mouth.

What are common causes of xerostomia?

Medications (400), certain diseases, radiation therapy, chemotherapy, and nerve damage.

What medications commonly contribute to xerostomia?

The slides specifically note that medications for high blood pressure and depression commonly cause dry mouth.

What nutrition strategies help xerostomia?

Increase hydration, sip liquids or suck on ice, try tart foods or sugarless candy, and use a straw if helpful.

What should be limited with xerostomia?

Caffeine, alcohol, tobacco, spicy/acidic foods, and excessive sugar.

What is stomatitis?

Inflammation of the mucous membranes lining the mouth or lips.

What can cause stomatitis?

Infections, physical or chemical irritation, micronutrient deficiencies, chemotherapy/radiation, medications, and systemic diseases.

Which nutrient deficiencies may contribute to stomatitis?

Iron and vitamins B2, B3, B6, B9, and B12.

What nutrition changes may help stomatitis?

Modify food texture and temperature as tolerated and avoid irritating foods or beverages such as carbonation.

What is glossitis?

Redness, swelling, and pain of the tongue.

What is cheilosis?

Fissuring and scaling at the corners of the mouth.

Which deficiencies may cause glossitis or cheilosis?

Riboflavin, folate, niacin, vitamin B6, vitamin B12, or iron deficiencies.

What is dysgeusia?

An altered or impaired sense of taste.

What is ageusia?

Complete inability to taste.

What can contribute to impaired taste?

Chemotherapy/radiation, oral disease, nervous system disorders, low saliva, medications, pregnancy, and deficiencies such as zinc or B12.

What nutrition problems can impaired taste cause?

Inadequate energy, protein, or fluid intake and unintended weight loss.

What are nutrition strategies for impaired taste?

Substitute poorly tolerated foods, maintain oral hygiene and hydration, try stronger flavors (tart/spicy) if tolerated, and avoid metal utensils when helpful.

What are the two major sphincters of the esophagus?

The upper/cricopharyngeal sphincter and the lower esophageal sphincter (LES).

What is the role of the epiglottis during swallowing?

It is part of airway protection and helps prevent food from entering the airway.

What is a bolus?

A mass of chewed food mixed with saliva that is ready to be swallowed.

What are the four phases of swallowing?

Preparatory, oral transit, pharyngeal, and esophageal phases.

What occurs during the preparatory phase of swallowing?

Food is chewed and mixed with saliva to form a bolus.

What occurs during the oral transit phase?

The tongue moves the bolus from the front of the mouth toward the pharynx.

What occurs during the pharyngeal phase?

The swallowing center (in the medulla) coordinates involuntary muscle actions that move the bolus while protecting the airway.

What occurs during the esophageal phase?

Peristalsis moves the bolus through the esophagus and LES into the stomach.

Which part of swallowing is voluntary versus involuntary?

Swallowing begins voluntarily, but after initiation the process is mainly under autonomic control.

What is the pharyngoesophageal segment (PES)?

The upper esophageal sphincter region, mainly formed by the cricopharyngeal muscle.
The vital muscular valve (ring-like structure) located at the junction between the lower throat (pharynx) and the top of the food pipe (esophagus)

Why is the PES important?

It normally remains closed (contracted) to protect the airway and opens during swallowing to allow the bolus into the esophagus.

What is dysphagia?

Difficulty or abnormality with swallowing.

What is the most serious complication of dysphagia?

Aspiration, when food or liquid enters the airway.

What nutrition complications can result from dysphagia?

Weight loss, dehydration, malnutrition, nutrient deficiencies, and inadequate oral intake.

What diseases commonly cause dysphagia?

Stroke, Parkinson disease, ALS, multiple sclerosis, myasthenia gravis, Alzheimer disease, GERD, achalasia, strictures, and head/neck cancers.

Which professional is especially involved in evaluating swallowing safety?

A speech-language pathologist (SLP).

What is the RDN's role in dysphagia management?

Ensure adequate nutrition/hydration and translate swallowing recommendations into appropriate foods and beverages.

What signs may suggest dysphagia or aspiration during meals?

Coughing, choking, throat clearing, pocketing food, delayed swallowing, drooling, or a wet/gurgly voice.

What is a bedside swallowing evaluation?

An assessment of cognition, oral function, ability to feed oneself, and swallowing of different liquids and food textures.

What is a Modified Barium Swallow Study (MBSS)?

A specialized, moving X-ray test used to evaluate how well you swallow. It allows a speech-language pathologist (SLP) and a radiologist to watch food and liquid move through your mouth, throat, and upper esophagus in real time

It detects swallowing safety, identifies abnormalities, and determines diet texture/water thickness to prevent aspiration

What can an MBSS help determine?

Safe food textures, liquid thickness, swallowing strategies, and need for therapy.

What is the International Dysphagia Diet Standardisation Initiative (IDDSI)?

The International Dysphagia Diet Standardisation Initiative, which standardizes food textures and liquid thicknesses for dysphagia.

What is IDDSI Level 0, 1, 2, 3, 4, 5, 6, 7?

0: Thin liquids

1: Slightly thick liquids

2: Mildly thick liquids, similar to traditional nectar-thick

3: Moderately thick liquids, similar to traditional honey-thick

4: Extremely thick liquids or pureed foods like mashed potatoes

5: Minced and moist like ground turkey

6: Soft and bite-sized food

7: Regular or easy-to-chew food

Why are liquids thickened for some patients with dysphagia?

Thicker liquids may move more slowly and can make swallowing safer for certain patients with aspiration risk.

What are examples of compensatory swallowing techniques?

Chin tuck, head turn, effortful swallow, supraglottic swallow, small bites/sips, alternating solids and liquids, and double swallowing.

What position/behavioral changes are recommended while eating with dysphagia?

Sit upright at approximately 90 degrees.

Eat slowly, avoid distractions, use small bites/sips, follow prescribed techniques, and maintain good oral care.

What are borborygmi?

Bowel sounds are produced as intestinal contents move through the GI tract.

They are created by the intestines

Normal sounds occur at a rate of 5-30 times per minute

What are hyperactive bowel sounds associated with?

Increased intestinal activity and conditions such as food intolerance or dumping syndrome.

louder, more frequent noises that may indicate increased intestinal activity

What can hypoactive or absent bowel sounds indicate?

Slowed GI activity, constipation, postoperative recovery, or ileus.

What is gastroesophageal reflux disease (GERD)?

Reflux of gastric contents from the stomach into the esophagus.

What normally prevents gastric contents from refluxing into the esophagus?

The lower esophageal sphincter acts as a barrier between the stomach and esophagus.

What causes GERD at the LES?

Transient relaxation, reduced LES pressure, or anatomical changes can make the LES incompetent and allow reflux.

When this muscular ring becomes weak or relaxes inappropriately, allowing caustic stomach acid to back up into the esophagus

What factors can decrease LES pressure and worsen GERD?

Increased secretion of hormose (gastrin), hiatal hernia, nicotine, certain medications (dopamine, morphine), pregnancy-related hormones (estrogen/progesterone), high-fat foods, chocolate, mint, alcohol, and caffeine.

What are common symptoms of GERD?

Heartburn, regurgitation, increased salivation, belching, dysphagia, and hoarse voice.

What are important complications of GERD?

Aspiration, aspiration pneumonia, esophageal ulcers, perforation, strictures, and Barrett's esophagus

What is Barrett's esophagus associated with?

The normal lining of the esophagus changes into a lining that resembles the tissue found in the intestines

Long-term GERD and chronic injury to the esophagus; it is an important complication because of increased cancer risk.

What are the major goals of GERD treatment?

Improve LES competence, reduce gastric acid, improve esophageal clearance, and reduce symptoms.

How do antacids treat GERD?

They neutralize existing stomach acid.

How do proton pump inhibitors (PPIs) treat GERD?

They block the H+/K+-ATPase enzyme and greatly reduce hydrochloric acid production.

Omeprazole, lansoprazole, pantoprazole, and rabeprazole

How do H2 receptor antagonists treat GERD?

They block histamine H2 receptors involved in stimulating gastric acid secretion.

Cimetidine and famotidine

What nutrient absorption concerns are associated with long-term acid-reducing medications?

Reduced absorption of calcium, iron, and vitamin B12 may occur.

How do prokinetic medications help GERD?

They increase GI motility and can strengthen LES function.

Metoclopramide (Reglan)

What are common side effects of magnesium-containing antacids?

Diarrhea.

What are common side effects of calcium carbonate or aluminum-containing antacids?

Constipation.

What is the difference between calcium carbonate and calcium citrate with acid-reducing therapy?

Calcium carbonate requires stomach acid and should be taken with meals, and requires less pills; calcium citrate does not require stomach acid and can be taken anytime, and requires more pills, and is more expensive.

Which calcium supplement contains more elemental calcium?

Calcium carbonate contains about 40% elemental calcium compared with about 21% in calcium citrate.

What are important lifestyle changes for GERD?

Eat smaller meals, avoid eating 3–4 hours before bed, elevate the head of the bed, manage weight, and identify symptom-triggering foods.

Why can lying on the left side help GERD?

The stomach remains positioned below the LES, helping gravity reduce reflux.

What foods commonly trigger or worsen GERD according to the slides?

High-fat foods, chocolate, peppermint/spearmint, alcohol, caffeine, spicy foods, and individually identified triggers.

Why are smaller meals recommended for GERD?

Large meals increase stomach volume and pressure, which can promote reflux.

What is a hiatal hernia?

Part of the upper stomach protrudes through the esophageal opening of the diaphragm into the thoracic cavity.

Incidence increases with age

What are the two major types of hiatal hernia?

Sliding (type 1): The most common type, where the junction between the esophagus and stomach slides up into the chest cavity together

Rolling (type 2): A less common but more dangerous type, where the junction stays in its normal place, but a portion of the stomach rolls up into the chest and sits right next to the esophagus

How are hiatal hernia symptoms commonly managed?

Management is often similar to GERD treatment; severe cases may require surgical repair.

What does gastric mucus do?

Protects the stomach lining from mechanical injury, pepsin, and gastric acid.

What do chief cells secrete?

Pepsinogen, which becomes active and begins protein digestion.

What do parietal cells secrete?

Hydrochloric acid and factors important for vitamin B12 absorption.

What are major functions of hydrochloric acid in the stomach?

Activates pepsinogen, denatures proteins, breaks down connective tissue, and kills microorganisms.

What do G cells secrete?

Gastrin, which stimulates gastric secretory activity including parietal, chief, and ECL cells.

What do ECL cells secrete?

Histamine, which stimulates parietal cells to secrete acid.

What do D cells secrete?

Somatostatin, which inhibits parietal, G, and ECL cells and reduces gastric secretion.

What is dyspepsia?

Persistent or recurrent indigestionIt is not a specific disease, but rather a cluster of symptoms originating from the upper gastrointestinal tract

Nonspecific upper abdominal discomfort that may include fullness, early satiety, nausea, bloating, belching, and gas.

What complications can prolonged vomiting cause?

Dehydration, acid-base imbalance, malnutrition, aspiration pneumonia, hematemesis, and tissue injury.

Over time can lead to food aversions (avoiding foods that make you vomit)

What is the first nutrition priority after repeated vomiting?

Replace fluids/electrolytes gradually after vomiting stops and correct dehydration and electrolyte problems.

How should food be reintroduced after vomiting?

Begin slowly with small amounts after vomiting has stopped, using lower-fat, lower-fiber, bland foods as tolerated.

What is gastritis?

Inflammation of the gastric mucosa.

What are common causes of acute gastritis?

Infection, alcohol, food poisoning, and NSAID use.

What is Type A chronic gastritis?

A chronic condition where your body’s immune system mistakenly attacks and destroys the cells lining your own stomach

An autoimmune form involving antibodies against parietal cells and intrinsic factor.