Disorders of the Upper GI System

Core Concepts

How the upper GI tract works

Food travels down the esophagus by peristalsis (waves of muscle contraction) and passes through the lower esophageal sphincter (LES), a muscle ring at the junction with the stomach that relaxes to let food in, then closes to keep stomach contents from splashing back up. The stomach stores and churns food while parietal cells secrete acid and chief cells secrete pepsinogen (precursor of the enzyme pepsin); its lining protects itself with mucus and bicarbonate.

GERD: when the barrier leaks

Gastroesophageal reflux disease (GERD) occurs when stomach contents reflux into the esophagus. The esophageal lining is not built to resist acid the way the stomach lining is, so repeated exposure causes irritation. Classic symptoms are heartburn (burning behind the breastbone) and regurgitation (acid back into the throat or mouth). Contributing factors include a weak or relaxed LES, hiatal hernia, obesity, pregnancy, and behaviors such as fatty meals, alcohol, tobacco, and eating close to bedtime. Chronic GERD can damage the esophagus: esophagitis (inflammation), strictures (narrowing that makes swallowing hard), and Barrett esophagus, a lining change that increases esophageal cancer risk and calls for ongoing surveillance.

Hiatal hernia

A hiatal hernia occurs when part of the stomach pushes up through the diaphragm into the chest. The common sliding type mainly worsens reflux. The less common paraesophageal type sits beside the esophagus and can become trapped or strangulated — a surgical emergency. Many cause few symptoms; others present like GERD.

Gastritis and peptic ulcer disease

Gastritis is inflammation of the stomach lining — acute (from NSAIDs, alcohol, severe illness, or infection) or chronic (often Helicobacter pylori or autoimmune). Symptoms range from none to dyspepsia, nausea, and pain. Peptic ulcer disease (PUD) is a deeper injury — a defect eroding through the stomach or duodenal lining. The two major contributors are NSAIDs (which weaken the lining's defenses) and *H. pylori* (which damages the lining and alters acid regulation). Classic teaching says gastric ulcers hurt soon after eating while duodenal ulcers hurt when the stomach is empty — but these patterns are unreliable; treat them as study aids, not diagnosis. Serious complications are bleeding (most common), perforation (a hole through the wall causing sudden severe pain and peritonitis), penetration, and obstruction. A "silent" ulcer can announce itself with bleeding, so blood in stool or vomiting blood is always taken seriously.

Dysphagia and upper GI bleeding

Dysphagia (difficulty swallowing) can be oropharyngeal (trouble moving food from mouth to esophagus, common after stroke) or esophageal (trouble moving food down the esophagus, from strictures, spasm, or growths). It raises the risk of choking and aspiration (food entering the lungs), which can cause pneumonia; patients often need swallowing evaluations and modified diets (see Parenteral and Enteral Nutrition).

Upper GI bleeding presents as hematemesis (vomiting blood — bright red, or "coffee-ground" if digested by acid) and/or melena (black, tarry stools from digested blood). Causes include bleeding ulcers, esophagitis, and esophageal varices — swollen veins in the esophagus that develop when liver disease raises portal pressure (see Hepatic and Biliary Disorders). Varices can rupture and bleed massively, so a person with known liver disease who vomits blood needs immediate attention. Nursing care focuses on assessment, keeping the patient NPO as ordered, IV access, and monitoring vital signs and output — exact protocols follow facility policy.

Nursing assessment and education

Assessment starts with the story: where is the pain, what brings it on, what relieves it, when does it happen, and are there warning signs (unexplained weight loss, vomiting blood, black stools, difficulty swallowing)? Teaching focuses on prevention and self-management: avoiding triggers within the person's control, not eating large meals close to bedtime, elevating the head of the bed for GERD, and reporting warning signs promptly. Scope note: nurses assess, educate, and monitor; diagnosing and treating (endoscopy, H. pylori therapy, surgery) are provider responsibilities, with institutional variation.

How It Works / Step-by-Step Process

1. Take the history: character and location of pain, timing, aggravating/relieving factors, medications (especially NSAIDs), and red-flag symptoms (weight loss, vomiting blood, black stools, dysphagia).
2. Assess: vital signs, general appearance, abdominal assessment, and mouth (for blood or poor dentition affecting eating).
3. Identify risk: NSAID use, H. pylori exposure, alcohol, tobacco, obesity, pregnancy, and liver disease history.
4. Educate: positioning (head of bed elevated for GERD), meal timing and size, avoidance of triggers, and how/when to take prescribed medications.
5. Monitor and report: watch for bleeding or perforation signs (sudden severe pain, rigid abdomen, vomiting blood, black stools, dizziness); report promptly and follow facility protocol.
6. Coordinate: refer for provider evaluation (endoscopy, H. pylori testing); involve dietitian or speech therapist when nutrition or swallowing is affected.

Common Confusions