Peptic ulcer disease is defined as sores that can develop in the stomach, small intestine, or esophagus. Ulcers that occur inside the lining of the stomach are classified as gastric. Duodenal ulcers occur on the first section of the small intestine, called the duodenum. Peptic ulcers occur when the protective mucus that lines the stomach becomes ineffective. When the mucosal barrier is breached (muscularis mucosae layer limits injury). Superficial damage limited to the mucosa, called erosions, can heal within hours to days but a breach in the mucosa that extends through the muscularis into the submucosa or deeper is called an ulcer. Peptic ulcers are chronic and most often solitary lesions that develop in any portion of the gastrointestinal tract exposed to acid or peptic juices.
Factors implicated in Peptic ulcers include;
- Increased acid secretion from, parietal cell hyperplasia and gastrin hypersecretion
- Smoking which impairs mucosal healing.
- Virulence factors – produced by H. pylori and involved in causing epithelial injury and inducing inflammation.
- Decreased inhibition of acid secretion – possibly by H. pylori damaging somatostatin-producing cells in antrum.
- Genetic susceptibility.
- Emotional stress (has effects on physiological processes and behaviors that may increase a person’s vulnerability).
The clinical features include, back pain, nausea, bloating, vomiting, heart burn, anorexia and weight loss particularly with Gastric ulcers, hematemesis (vomiting blood), malaena and perforation resulting in peritonitis. Despite these clinical features many cases are asymptomatic.
The treatment of ulcer includes both medical and diet therapy interventions. With the medical treatment the primary aim of treatment is the eradication of H. pylori by the use of drug protocols such as antibiotics and bismuth or a proton pump inhibitors, H2 blockers etc. Nonetheless in severe ulcers sometimes surgery is needed. With the drug therapy, the goal of ulcer treatment is to relieve pain, promote healing, and prevent recurrence. In addition, the use of tobacco products, alcohol, NSAIDs, and aspirin interfere with several aspects of therapy and increase the risk of complications.
Nutrition intervention of Peptic Ulcer Disease
The goals for nutrition therapy include supporting medical treatment, maintaining or improving nutritional status, and providing a diet that minimizes symptoms of peptic ulcer disease.
For patients with PUD, symptomatic abdominal pain can impair oral intake and result in weight loss and/or nutrient imbalances.
Foods to be restricted includes
- Pepper (black and red)
- Avoid foods that are not tolerable
- Avoid lying down after eating
- Avoid eating large meals close to bedtime
The pH of a food prior to its consumption has little effect after it is consumed. Restricting acidic juices or other foods is not consistently warranted unless the patient identifies intolerance to them.
Tips to consider
- Eat smaller but frequent meals and ensure adequate timing
- Eat variety of fruits and vegetables (antioxidants inhibit acid secretion, and contain cytoprotective and anti-inflammatory properties).
- Includes fiber rich foods in your diet especially soluble fiber.
- Probiotics: Food that contains active bacterial content, such as probiotic yogurt, can help to reduce a Helicobacter pylori (H. pylori) infection. Probiotics have been shown to slightly improve symptoms of indigestion and the side effects of antibiotics.
- Antioxidants such as Vitamin C (powerful antioxidant may be effective in helping to eradicate H. pylori, especially when taken in small doses over an extended period. Fruits, legumes, and vegetables, such as oranges and tomatoes, contain high levels of vitamin C).
- Zinc: This micronutrient is important for maintaining a healthy immune system and healing wounds. Oysters, spinach, and beef contain high levels of zinc.
- Selenium: This may reduce the risk of infection complications and may also promote healing. Shell fish, Brazil nut, tuna, tofu, lean meat, shrimp, and whole wheat pasta.