PEPTIC ULCER
This includes both gastric (stomach) and duodenal ulcers.
PATHOPHYSIOLOGY AND AETIOLOGY:
In ulcer patients, the mucosa is not sufficiently resistant to the acids secreted by the stomach. If just the superficial cells are involved, the lesions is called an erosion. If the muscular layer of the stomach or duodenum is involved, the person has an ulcer.
Gastric ulcers are more common the right side of the stomach, while duodenal ulcers account for 60% of all ulcers, and are associated with increased acidity of the stomach.
• The majority of all peptic ulcers are related to Helicobacter Pylori infection.
• The second most common cause is related to the excessive of NSAIDs (Nonsteroidal Antiinflammatory Drugs) such as aspirin, ibuprofen and naproxen.
H. Pylori and NSAIDs break down the stomach or intestine’s protective mucus layer, leading to peptic ulcer. Long term use of other medications, such as potassium chloride (KCl) and corticosteroids is also associated with ulcer formation.
Smoking, alcohol, coffee and stress are all predisposing factors.
Genetic factors, physical factors such as imbalance between the gastric acid and pepsin secretions and inability of the mucosa to resist these secretions.
SIGNS AND SYMPTOMS
1. A gnawing burning epigastric pain, when the stomach is empty, characterizes duodenal ulcer. This occurs 1─3 hrs after eating or at night.
2. With gastric ulcer, the pain is made worse by ingesting food, or is unrelated to food intake.
3. Bleeding, experienced by one fourth of ulcer patients, which occur more often with duodenal than with gastric ulcers.
4. Coffee ground emesis, which means vomiting of blood immediately after bleeding begins. The vomitus is brown black and granular
5. nausea, anorexia and sometimes, weight loss
MANAGEMENT
• Drug Therapy: this includes use of antacids to neutralise excess gastric acid secretion
• Rest
• Nutritional therapy
• In severe cases surgery
RATIONALE FOR DIET INDICATION
The objective of peptic ulcer diet therapy is to prevent hyper secretion of HCL acid in order to reduce the sore and pain in the gastric and duodenal mucosa. Also, nutrition therapy aims to promote healing, based on a complex sequence of events, going from the initial trauma to the repair of the damaged tissue.
In nutritional therapy the traditional approach is provision of bland diet and small frequent meals, and modification of food consistency.
The liberal approach is to consider the traditional approach and relate it to the available scientific backing treating each patient individually.
DIET PLAN
Calories distribution should be adjusted according to the patient’s needs, so as to normalize the nutritional status, having a protein intake of 1.2g/kg/BW/day in the acute stage (5th ─8th week) and up to 1.5g/ BW/day in the recovery stage.
CHO should be adjusted to the patients needs, without disaccharides concentration, so as to avoid fermentation. Also, lipids, without concentration of saturated fats.
Micronutrients, such as zinc, is needed to maintain the immune system function, as a response to oxidative stress and to heal wounds.
Also, selenium may be used to reduce infection complications and improve healing, together with vitamin A.
A fibre rich diet (20─30 g/day) intake advisable,(more of soluble fibre) because fibres act as buffers, reducing concentrations of bile acids in the stomach and the intestinal transit time, resulting in less abdominal bloating, thus decreasing discomfort and pain the G.I.T.
MEAL PLAN
Morning: Skimmed milk + boiled egg
Afternoon: soft semo + okro + fish
Night; Cooked rice + Vegetable salad + natural juices (not coffee nor citrus nor acidic fruit juices)
Snack: Apple/ banana/ walnuts,/carrots.
Food Groups Allowed Use With Caution Prohibited
Dairy Milk, low fat cheese, yoghourt Fatty or cream cheese ─
Oil Seeds Flax seeds, walnuts ─ ─
Oils Vegetable oils, olive oils
─ Fried foods
Fruits Apple, paw─paw, banana Orange, pineapple,lemon
Vegetables Leafy dark green vegetables, carrot, spinach, leek, radish, zucchini, green beans Broccoli, cauliflower, cabbage, cucumber, onion, red pepper Spicy peppers (black pepper, chilli)
Meats Lean meat (beef, pork, fish, chicken) Fatty meats, organ meats and sausages ─
Beverages Natural juices Citrus/acidic fruit juices Coffee, black tea, cola drinks
This includes both gastric (stomach) and duodenal ulcers.
PATHOPHYSIOLOGY AND AETIOLOGY:
In ulcer patients, the mucosa is not sufficiently resistant to the acids secreted by the stomach. If just the superficial cells are involved, the lesions is called an erosion. If the muscular layer of the stomach or duodenum is involved, the person has an ulcer.
Gastric ulcers are more common the right side of the stomach, while duodenal ulcers account for 60% of all ulcers, and are associated with increased acidity of the stomach.
• The majority of all peptic ulcers are related to Helicobacter Pylori infection.
• The second most common cause is related to the excessive of NSAIDs (Nonsteroidal Antiinflammatory Drugs) such as aspirin, ibuprofen and naproxen.
H. Pylori and NSAIDs break down the stomach or intestine’s protective mucus layer, leading to peptic ulcer. Long term use of other medications, such as potassium chloride (KCl) and corticosteroids is also associated with ulcer formation.
Smoking, alcohol, coffee and stress are all predisposing factors.
Genetic factors, physical factors such as imbalance between the gastric acid and pepsin secretions and inability of the mucosa to resist these secretions.
SIGNS AND SYMPTOMS
1. A gnawing burning epigastric pain, when the stomach is empty, characterizes duodenal ulcer. This occurs 1─3 hrs after eating or at night.
2. With gastric ulcer, the pain is made worse by ingesting food, or is unrelated to food intake.
3. Bleeding, experienced by one fourth of ulcer patients, which occur more often with duodenal than with gastric ulcers.
4. Coffee ground emesis, which means vomiting of blood immediately after bleeding begins. The vomitus is brown black and granular
5. nausea, anorexia and sometimes, weight loss
MANAGEMENT
• Drug Therapy: this includes use of antacids to neutralise excess gastric acid secretion
• Rest
• Nutritional therapy
• In severe cases surgery
RATIONALE FOR DIET INDICATION
The objective of peptic ulcer diet therapy is to prevent hyper secretion of HCL acid in order to reduce the sore and pain in the gastric and duodenal mucosa. Also, nutrition therapy aims to promote healing, based on a complex sequence of events, going from the initial trauma to the repair of the damaged tissue.
In nutritional therapy the traditional approach is provision of bland diet and small frequent meals, and modification of food consistency.
The liberal approach is to consider the traditional approach and relate it to the available scientific backing treating each patient individually.
DIET PLAN
Calories distribution should be adjusted according to the patient’s needs, so as to normalize the nutritional status, having a protein intake of 1.2g/kg/BW/day in the acute stage (5th ─8th week) and up to 1.5g/ BW/day in the recovery stage.
CHO should be adjusted to the patients needs, without disaccharides concentration, so as to avoid fermentation. Also, lipids, without concentration of saturated fats.
Micronutrients, such as zinc, is needed to maintain the immune system function, as a response to oxidative stress and to heal wounds.
Also, selenium may be used to reduce infection complications and improve healing, together with vitamin A.
A fibre rich diet (20─30 g/day) intake advisable,(more of soluble fibre) because fibres act as buffers, reducing concentrations of bile acids in the stomach and the intestinal transit time, resulting in less abdominal bloating, thus decreasing discomfort and pain the G.I.T.
MEAL PLAN
Morning: Skimmed milk + boiled egg
Afternoon: soft semo + okro + fish
Night; Cooked rice + Vegetable salad + natural juices (not coffee nor citrus nor acidic fruit juices)
Snack: Apple/ banana/ walnuts,/carrots.
Food Groups Allowed Use With Caution Prohibited
Dairy Milk, low fat cheese, yoghourt Fatty or cream cheese ─
Oil Seeds Flax seeds, walnuts ─ ─
Oils Vegetable oils, olive oils
─ Fried foods
Fruits Apple, paw─paw, banana Orange, pineapple,lemon
Vegetables Leafy dark green vegetables, carrot, spinach, leek, radish, zucchini, green beans Broccoli, cauliflower, cabbage, cucumber, onion, red pepper Spicy peppers (black pepper, chilli)
Meats Lean meat (beef, pork, fish, chicken) Fatty meats, organ meats and sausages ─
Beverages Natural juices Citrus/acidic fruit juices Coffee, black tea, cola drinks
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