Peptic ulcer..How to treat peptic ulcer by diet.

Peptic ulcer 

The term peptic ulcer is used to describe any localized erosion or disintegration of the mucosal lining that comes in contact with gastric juice. Mostly the oesophagus, stomach and duodenum lining is affected and cause stomach and duodenal ulcers (peptic ulcers). 

Peptic ulcers are one of the most serious forms of gastrointestinal disorders of the gastrointestinal tract. 

Areas affected in peptic ulcer: Although theoretically, the entire gastrointestinal tract lining may be affected by ulcer, the following areas are the most affected- 

1. Lower part of the oesophagus. 

2. Stomach (especially the lesser curvature or antrum).

3. First portion of the duodenum, also called the duodenal bulb. 

Actiology: Pepitc ulcer results when the neural and hormonal abnormality disrupts the factors that normally maintain mucosal integrity and permit proteolytic and acidic erosion of the mucosal tissue.

Factors affecting mucosa: 

Destructive Factors: 

1. Hydrochloric acid 

2. Pepsin (Proteolytic enzyme) 

3. Psychological factors (stress and anxiety) 

4. Gastric irritants (alcohol, caffeine, excess tea, meat extracts and spices) 

5. Nicotine and Tobacco 

6. Anti inflammatory drugs / Analgesics

Definsive Factors: 

1. Epithelial cell barrier 

2. Mucous 

3. Gastric blood flow

4. Regulation of acid secretion

5. Ability of the body to regenerate the cells

Some of the common actiology factors include- 

1. Helicobacter pylori infection: It is a bacterium commonly found in the stomacd associated with chronic ulcer and gastritis. 

2. Genetic factos: It is believed that those people who have close relatives suffering from peptic ulcer especially duodenal ulcer are found to be more prone to develop this disease and so there is a genetic predisposition. 

3. Sex: Both men and women have almost equal chances of developing peptic ulcer, although some suggest that men may be affected 2-3 times more. 

4. Age: Peptic ulcer is commonly seen in people between the age group of 20-40 years, since this is the time period when there is excess physical and mental stress, but may occur at any ages.

5. Personality: Human beings are divided into two groups-type A and type B. Type A are more competitive and lead a more stressful life, whereas type B individuals lead a mere relaxed life. Type A personality are more prone to develop peptic ulcer.

6. Stress: Stress leads to hypersecretion and hypermotility of the stomach and thus leads to peptic ulcer.

7. Foods: Irritating foods like spices, tea, coffee, caffeine, etc. can induce peptic ulcer.  Moreover, the frequency of the diet and it's type can also lead to peptic ulcer. 

8. Irregular and hurried eating due to occupational reasons or habit or any other such causes. 

9. Prolonged consumption of NSAID (Non Steroidal Anti Inflammatory Drugs), corticoid drugs and painkillers cause peptic ulcer.

Symptoms: 

1. Pain in the stomach (epigastric pain) and related area; pain can be dull, piercing, burning or gnawing. 

2. Frequent vomitting, sometimes with blood loss (melena) increased gastric tone 

3. Painful hunger contractions when stomach is empty (hunger contractions 1-3 hours after meal)

4. Heart burn 

5. Discomfort and flatulence, especially in the upper part of the abdomen. 

6. Weight loss and generalized malnutrition 

7. Melena (black stool) 

8. Haematemesis (blood vomitting) 

9. Anorexia 

10. Dyspepsia 

11. Frequent burping

Diseases Associated with peptic ulcer: 

• Gastrointestinal bleeding 

• Intestinal perforation 

• Peritonitis (inflammation of the lining of the abdominal cavity) 

• Anaemia 

• Intestinal narrowing and obstruction 

• Shock 

Management: To provide physiological rest and support tissue healing, treatm be based on providing rest to the affected areas. 

The management of peptic ulcer includes the following techniques.

A. Nutritional Management: It is well known that a good dietary regime  and nutritional status can help in reducing the impact of the disease on the overall health. being of the patient.

The objectives of the nutritional care process should include the following points: 

1. Restoration of good nutritional status with dietary modifications and counseling. 

 2. Alleviate the symptoms. 

 3. Neutralize the acids.

4. Reduce acid secretion. 

 5. Preservation of epithelial resistance to the destructive action of gastric juice. 

 The basic principles of dietary management include the following- 

Energy: The energy intake should be such as to help the patient in achieving and maintaining an ideal body weight. An adequate energy intake is a must to prevent subsequent weight loss and spare the proteins for healing of ulcers. 

Proteins: Ulcer is a form of wound which if not healed on time can get perforated a bleed. Adequate protein intake ensures synthesis of new tissues essential for healing. 

Milk is a protein-rich food which is valued in peptic ulcer because. 

 • it has buffering action against the gastric acid.

• provides amino acids for healing the ulcer. 

• contains prostaglandin PGE 2-a protective agent against stress induced ulcers. 

 • liquid food and so low in fiber, thus is non-irritating in nature. 

Milk was believed to be best for peptic ulcer patient but now it is seen that one thousand neutralizes gastric acidity only for 20-60 mins after its ingestion. Diet containing milk in high amounts has an adverse effect on the healing rate of ulcer because of high calcium content. It provides protein digestion products (amino acids and polypeptides) which stimulate gastric acid secretion. 

Proteins from cottage cheese, egg, chicken and fish in adequate amounts is beneficial for regeneration of cells.

Fats: Fats may be given in moderate amounts because- 

1. They can delay gastric emptying. 

2. Products of fat digestion stimulate. enterogastrone, which inhibits gastric juice secretion. 

3. PUFA like linoleic and eicosapentaenoic acid have been effective agaist duodenal ulcers by inhibiting the growth of H. pylori. 

Around 25-30 gm of visible fat may be incorporated in the daily diet. Emulsified fats are better tolerated. 

Carbohydrates: Carbohydrates should provide about 55-65% of the daily intake. Simple sugars are suggested as well as some amount of complex carbohydrates. Soluble fibers are more beneficial than insoluble fibers.

Other factors to be considered: 

1. low acidic foods should be given.

2. Spices, herbs and condiments and other irritating items should be avoided. 

3. Alcohol causes a damage to the intestinal mucosa and so should be avoided. 

4. Nicotine of cigarettes has an adverse effect on mucosa and increases gastric acid secretion. 

5. Gas forming foods like pulses, cabbage, cauliflower, etc, may cause irritation and so should be avoided. 

6. Small, frequent meals are better tolerated. 

7. More than three regular meals should be eaten.

8. Eating should be done in relaxed atmosphere. 

9. Adequte rest and sleep is necessary. 

B. Other management techniques: Other than diet, a number of other management techhiques are present. These include- 

1. Lifestyle modifications like avoiding smoking, alcohol consumption, etc.

2. Behavioral modifications like avoiding stress, maintaining regular meal times, etc. 

3. Intake of proper medications.

Peptic ulcer is caused by Hurry, Worry & Curry and for proper management, these should be controlled. 

Different Types of Diets Used in Peptic Ulcer:

1. Sippys diet and its modification by Hurst (now no longer used): Hourly feeds of milk, cream and olive oil with antacid medication.

2. Lenhartz diet: Fluid diet containing milk and egg.

3. Meulengracth diet: A mixed bland diet containing milk, egg, meat and fish (minced and strained) given once in 2 hours. 

4. Anderson's diet: Mixture of milk. cream, dextrose and gelatin.

5. Soya and peanut milk diet: For people who are allergic to animal milk, a blend of soya and peanut milk containing dextrose and gelatin can be used. 

Foods to be Included: Dairy products like milk, cream, butter, mild cheese and eggs (not fried), steamed fish, rice, riceflakes, puffed rice, well cooked cereal, semolina, cooked green leafy vegetables, custards, malted drinks, cooked pulses (if they are not causing gas formation).

Foods to be Avoided: Alcohol, strong tea, coffee, cola beverages, gravies, pickles, spices, chillies, curries, condiments, all fried foods, pastries, cakes, heavy sweets like halwa, barfi, raw unripe fruits, raw vegetables like cucumber, onions, radish and tomatoes.