Prevention/dietary management of peptic ulcer

What is peptic ulcer?

This is the ulceration of the gastro intestinal mucosa which is caused by destruction of the normal balance of the corrosive effects of gastric juice and the protective effect of mucus on the gastric epithelia cells. This may occur when pepsin and acid are present in abnormally high concentration. A peptic ulcer maybe found in the oesophagus.

The lining of the stomach and duodenum is washed by corrosive acid and salt. Naturally the digestive system has mechanism to cope with this, but if the mechanism break down inflammation and eventually ulceration occurs.

Mechanisms of ulcer formation

The three vital mechanisms are:

• Mucous layer
• Prostaglandins
• Urogastrone/epidermal healing factor (URO/EHF)

These mechanisms can protect the stomach against hydrochloric acid up to twice the maximum concentration which the stomach is capable of secreting.

Mucous layer

The mucous layer, viscous gel ideally suited for its function of protection from chemical and physical hazards of water proofing and lubrication.

Prostaglandins

They are released locally in the mucosa and sub mucosa in response to any irritant stimulus. They instantly accelerate all replacement, opening up the micro circulation to bring cell nutrients and to remove toxic metabolites.

Urogastrone

It plays an important role by inhibiting gastric acid secretion on the one hand and by stimulation of cell proliferation and regeneration on the other hand for healing ulcer.

Types of peptic ulcer

• Duodenal ulcer
• Gastric ulcer

Duodenal ulcer

An ulcer in the duodenum, caused by the action of acid and pepsin on the duodenal lining (mucosa). In this condition hyper secretion of acid is found although tissue resistance is normal.

Gastric ulcer

Gastric ulcer is an ulcer in the stomach caused by the action of acid, pepsin and bile on the stomach lining (mucosa). Factors that contribute to weakened mucosal resistance in patients with gastric ulcer revolve around poor nutrition, diminished mucosal. Blood flows and a defect in the inhibition of gastric acid and pepsin secretion.

Aetiology of peptic ulcer

• Bacteria infection: Helicobacter pylori is the chief cause of ulcer. It is spiral shaped with gram negative unipolar flagelium. It colonises the stomach in about 50 percent of all humans.
• Genetic factor: it is common in persons with blood group “O” than in those of other groups.
• Sex: Men are affected two or three times more frequently than women.
• Stress: People who are highly nervous and emotional and who worry, fear and feel anxiety are particularly susceptible.
• Potentially irritant substances: Caffeine, ethanol, aspirin and nicotine may delay healing but there is little evidence to show that these substances induce ulcer. Chillies, pepper, ginger, meat soup, strong tea or coffee and protein rich foods, Increase the secretion of hydrochloric acid and aggravate the condition.
• Age: The incidence is high between 20 and 40 years though the average age of incidence has increased.

Symptoms of peptic ulcer

• Discomfort and flatulence
• Bleeding ulcer can result in vomiting known as haematemesis
• Epigastric pain, heart burn, etc due to reflux of acid into oesophagus occurring as deep hunger contraction 1 to 3 hour after meal.
• Pain: burning pains behind the breast bone (upper abdomen).

1. Food may help or worsen the pain
2. If food worsen pain and food is avoided causing weight loss and iron deficiency anaemia
3. Pain may wake you up at night

• There are spams of pyloric canal and this may give rise to a feeling of sickness distention, and prevent taking of food.

Diagnosis of peptic ulcer

• Radiographic examination with barium meal: the techniques, though simple, carries a fairly substantial risk of missing the problem.
• Endoscopy: A flexible tube made of fibre optic bundles is introduced into the stomach and the endoscopist inspects the food pipe and stomach and defect any breaks in the lining membrane. It takes 15 – 20 minutes.
• Biopsy: biopsy of lining tissues is done

Treatment of peptic ulcer

• Diet
• drugs E.g. antacid, anti-spasmodic drug
• Rest

Therapeutic goals of peptic ulcer                                                                                        

• To relieve the symptoms
• To allow healing of ulcer
• To prevent complication like surgery

Drugs used for the treatment of peptic ulcer

Antibiotics against helicobacter pylori should be given. It is important to neutralize the excess acid produced.

• Antacid and anti-spasmodic drugs
• A group of chemicals are available that block certain vital steps in acid production by the stomach-H₂ They are effective, devoid of major side effects and are given once or at most twice daily.

Dietary management of peptic ulcer

• A regular diet, including good sources of dietary fibre, has proven to be beneficial.
• Moderate amounts of fat help to suppress gastric secretion and motility through the enterogastrone mechanism. Fat such as cream, butter and olive oil can be particularly helpful in a thin patient.
• It is assumed that low antioxidant levels predispose helicobacter pylori infection. It would be prudent for people with H. pylori infection to increase their intake of vitamin C. It helps in wound healing.
• Milk should be included as a source of nutrient factors for healing purpose.
• Strongly flavoured vegetables such as cabbage, cauliflower, onions and turnips and fried foods should be restricted from the diet.

Dietary guidelines for peptic ulcer patients

• Moderate use of seasoning is permitted.
• Regularity of mealtimes is essential. The patient gets benefited by small and frequent meals.
• In between meals, protein rich snacks should be taken
• Moderate amounts of food should be eaten. Heavy meals should be avoided.
• Food should be eaten slowing and chewed well. How one eats is more important than what one eats because fast eating provokes gastric feeding reflex.

Complications of peptic ulcer

• Bleeding ulcer
• Perforated ulcer
• surgery

Prevention of peptic ulcer

• Eat regular meals
• Reduce the use of spices in food
• Proper mastication/chewing of food before swallowing
• Avoid prolong fasting period
• Avoid emotional stress, anxiety, fear
• Avoid smoking and alcohol
• Avoid taking drugs on empty stomach
• Avoid self medication
• Avoid fried and greasy food

In conclusion, symptoms may last for some period and disappear completely without treatment only to re-occur after an interval of 2 to 3 months. It is advisable to eat right, chew food properly, avoid fasting, go for medical check-up and stay healthy.