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Item ID: MON272   Source ID: 2

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by Maria Adams, MS, MPH

Anatomy and Physiology
The upper digestive system is made up of: the mouth, the esophagus, the stomach, the duodenum, which is the uppermost portion of the small intestine. Your upper digestive system and the remainder of the small intestine are responsible for much of the digestive process. Digestion begins in the mouth. From there, food travels down the esophagus and into the stomach for further digestion. Eventually, the food reaches the small intestine, where the majority of nutrients are absorbed into the bloodstream.

Reasons for Procedure
An upper GI endoscopy may be recommended if you have: abdominal pain, severe heartburn, persistent nausea and vomiting, or regurgitation of food, difficulty swallowing, bleeding from the gastrointestinal tract, abnormal x-ray exams or other examinations of the gastrointestinal tract.

Conditions that can be diagnosed, and occasionally treated, with an upper GI endoscopy include: ulcers of the esophagus, stomach, or duodenum, infection of the stomach with H. pylori, a bacterium that leads to ulcers, tumors, or small growths called polyps, abnormal narrowing, called a stricture, of the upper GI tract, inflammation of the upper GI tract, presence of a foreign object, hiatal hernia, which is an abnormal opening through a portion of the stomach that can rise into the chest.

Treatments
An upper GI endoscopy is a procedure that allows your doctor to view the lining of your esophagus, stomach, and duodenum. The purpose of an upper endoscopy is to find the cause of, and sometimes treat, symptoms originating from your upper digestive system.

A barium x-ray study is sometimes used as an alternative to an upper endoscopy. A drawback of this procedure is that it is a less sensitive test for inflammation and small ulcers, and cannot diagnose an H. pylori infection.

Procedure
An upper GI endoscopy usually takes about 15 minutes. Most people find the procedure only a bit uncomfortable, and some even fall asleep. You should not eat or drink for 8-10 hours before the procedure. Any food in the stomach blocks the view of the endoscope, and vomiting of solid food can result in aspiration, or food going into the lungs.

Before your procedure, your doctor will offer you a sedative to help you relax. Your doctor may also give you intravenous pain medication and spray your throat with a local anesthetic to numb it. You will be asked to lie on your left side and a supportive mouthpiece will be placed in your mouth.

Your doctor will then place the endoscope in your mouth and gently guide it down your esophagus, stomach, and into your duodenum. An endoscope is a thin, flexible tube with a tiny light and video camera at the end. Your doctor will send air through the endoscope to give him or her a better view.

Your doctor will view the images transmitted by the endoscope on a TV monitor. Based on what he or she sees, your doctor may retrieve a tissue sample for further study, test for the presence of bacteria, remove polyps, or treat a bleeding ulcer.

Risks and Benefits
Complications during an upper GI endoscopy are rare, but may include: bleeding in the upper GI tract, accidental tearing of the esophagus, stomach, or duodenum, pneumonia, from vomited material that enters the lungs, infection, adverse reaction to medications.

Benefits of an upper endoscopy include: diagnosis of ulcers and a variety of other conditions affecting the upper GI system, collection of material for H. pylori testing, treatment of polyps, bleeding ulcers, and other upper GI conditions.

In an upper GI endoscopy, or any procedure, you and your doctor must carefully weigh the risks and benefits to determine whether it's the most appropriate intervention for you.

After the Procedure
After the procedure, you will be observed for about an hour, until most of the effects of the medication have worn off. Your throat may be sore, and you may feel a bit bloated from the air that was introduced into your digestive system during the endoscopy.

Upper endoscopies are usually performed on an outpatient basis. When you leave the hospital, you will be advised to: not drive or operate machinery for 24 hours, not drink alcohol for at least 24 hours, get plenty of rest throughout the remainder of the day.

Depending on what is done during your procedure, you may or may not be able to resume your normal diet soon after the procedure. Follow your doctor's guidance.

Call your doctor if any of the following occurs: increasing or persistent pain, bleeding, fever, black or tarry stools, nausea and vomiting, difficulty breathing, difficulty swallowing, worsening of your original symptoms.

Sources:

  • EGD - esophagogastroduodenoscopy. Medline Plus. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/003888.htm Accessed March 8, 2004.

  • Understanding Upper Endoscopy. American Society for Gastrointestinal Endoscopy.Understanding colonoscopy. American Society for Gastrointestinal Endoscopy website. Available at: www.asge.org/gui/patient/colon.asp. Accessed July 31, 2003.

  • Upper Endoscopy. National Digestive Diseases Information Clearinghouse (NIDDIC).Upper Gastrointestinal Endoscopy - Open Access. Queensland Health. Available at: http://203.147.140.236/informedconsent/ConsentForms/surgery/Upper%20GI/upper_%20GI_endoscopy_oa.pdf. Accessed March 2, 2004.

  • What is Upper GI Endocsopy? The American Gastroenterological Association. Available at: http://www.gastro.org/public/brochures/uppergi.html. Accessed March 5, 2004.



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