Peptic Ulcer Disease

Peptic ulcer disease
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Introduction

What is peptic ulcer disease?

Peptic Ulcer Disease is a condition in which the stomach and small intestine lining are slowly eroded away. By an acid-resistant bacterial infection Helicobacter pylori bacteria (H.Pylori).

Causes of Peptic Ulcer Disease

The disease is caused by heavy use of aspirin and related medications, and disorders that causes excessive acid production in the stomach. Stress is also regarded as a predisposing factor, for ulcers.

As the stomach lining deteriorates and loses its mucus layer protection, the acid erodes the stomach tissue. This specific chain of events results in gastric ulcer. Acid can also erode the tissue lining of the first part of the small intestine, the duodenum, and result in a duodenal ulcer. Peptic ulcer is the general term for both types of ulcers.
Most ulcers in young people occur in the duodenum; in older people they occur primarily in the stomach.

A person performing a H. pylori urea breath test. The inset shows what the H. pylori bacteria look like.

Symptoms of Peptic Ulcer Disease

The typical symptom of ulcers is pain about 2 hours after eating. Digestive acids acting on a meal irritate the ulcer after most of the meal has moved to the jejunum area of the small intestine.

The primary risk associated with an ulcer is the possibility that it will erode entirely through (perforate) the stomach or intestinal wall. The Gastro-intestinal contents could then spill into the body cavities causing a massive infection, called peritonitis. In addition an ulcer may erode a blood vessel, leading to massive blood loss (haemorrhage). For these reasons, it is important not to ignore the early warning signs of ulcer development. Infected persons have an increased lifetime risk of gastric adenocarcinoma (stomach cancer). Accurate, inexpensive, and non-evasive tests are available to diagnose H.pylori infection.

Prevention and treatment

Dietary guidelines

In the past, milk, and creamy therapy- the "sippy" diet- was used to help cure ulcers. Clinicians know now that milk and cream are two of the worst foods for an ulcer. The calcium in these foods stimulate stomach acid production and actually inhibit the healing of an ulcer.

Restrict or avoid foods that may cause gastric irritation and excessive gastric acid secretion and help prevent uncomfortable side effects such as heartburn.

Dietary guidelines that may help decrease reflux and/or stomach acid:

Eat three small meals and three snacks evenly spaced throughout the day. It is important to avoid periods of hunger or overeating.
Eat slowly and chew foods well.
Be relaxed at mealtime.
Sit up while eating and for 1 hour afterward.
Avoid eating within 3 hours before bedtime. Bedtime snacks can cause gastric acid secretion during the night.
Choose foods from the low fat diet and low fat guidelines in addition to the following diet
Cut down on caffeine-containing foods and beverages, citrus and tomato products, and chocolate if these foods cause discomfort.
Include a good source of protein (milk, meat, egg, cheese, etc.) at each meal and snack.
Antacids should be taken in the prescribed dose, One-hour before and 3 hours after meals and prior to bedtime. This regimen is most likely to keep the acidity of the stomach at the most stable and lowest level.
Milk and cream feedings should not be used as antacid therapy. Although milk protein has an initial neutralizing effect on gastric acid, it is also a very potent stimulator. Hourly feedings of milk have been shown to produce a lower pH than three regular meals.
Caffeine-containing beverages (coffee, tea, and cola drinks) and decaffeinated coffee cause increased gastric acid production but may be taken in moderation at or near mealtime, if tolerated
There is little rationale for completely eliminating any foods from the diet unless a particular food causes you repeated discomfort.
Identify foods that repeatedly cause discomfort or irritability of the stomach and eliminate them from your diet.

Recommendations to prevent ulcers and Heartburn form occurring or recurring

Ulcers

Stop smoking, if you are a smoker
Avoid large doses of aspirin ibuprofen/brufen, NSAID compounds unless prescribed by a physician,
Limit consumption of coffee, tea, alcohol (especially wine) if this helps
Avoid consumption of carbonated drinks, especially with a straw.
Limit consumption of pepper, chilli powder and other strong spices if this helps
Eat nutritious meals on regular schedule, don't skip meals and include enough dietary fibre.
Chew your food well
Lose weight if currently overweight

Heartburn

Wait about 2 hours after a meal before lying down
Don't over eat at meal times - smaller meals that are low in fat are advised
Observe the recommendations for ulcer prevention
Do not lie flat especially after food, raise/lift the bed
Stop smoking
Lose excess weight

FOODS RECOMMENDED	FOODS THAT MAY CAUSE DISTRESS
Breads and grains 6-11 servings each day Whole-grain or enriched, seedless breads Whole-grain or enriched cereals Enriched rice, barley, noodles, spaghetti macaroni, and other pastas French toast, muffins, pancakes, and waffles made with low-fat ingredients Low fat crackers	Very high consumption of breads & grains Breads and cereals prepared with high-fat ingredients such as croissants, biscuits, and granola-type cereals Very acidic foods
VEGETABLES 3-5 servings each day Fresh, frozen, or canned vegetables as tolerated	VEGETABLES Raw vegetables, corn Gas forming vegetables such as: broccoli, Brussels sprouts, cabbage, onions, cauliflower, cucumber, green pepper, rutabagas, turnips and sauerkraut Vegetables prepared with added fat Tomatoes and tomato products
FRUIT 2-4 servings each day Fresh, frozen, and canned fruits as tolerated Fruit juice as tolerated Grapefruit and orange sections without membrane	FRUIT Lemons, grapefruit, oranges, pineapples, and tangerines Citrus juices such as orange, pineapple and grapefruit juice Berries and figs
MILK & DAIRY 2-3 servings each day Low fat and non-fat milk and milk products Processed cheese with less than 5 grams of fat per ounce Plain mild cheeses Low-fat cottage cheese Low-fat and nonfat yogurt	MILK & DAIRY Whole milk and chocolate milk Buttermilk made with whole milk Evaporated whole milk and cream Strong flavored cheeses
MEAT & MEAT SUBSTITUTES 2-3 servings or total of 6 oz daily All lean, tender beef, pork, lamb, veal, and poultry (without the skin) All fresh, frozen, or canned fish packed in water Crisp bacon; lean ham Eggs (limit to 3-4 egg yolks weekly) Smooth peanut butter and nut butter Soybean curd (tofu) and other meat substitutes Dry beans and peas prepared without fat Soups Mildly seasoned meat stock or cream soups made with allowed foods	MEAT & MEAT SUBSTITUTES Highly seasoned, meats, poultry or fish such as corned beef, luncheon meats, frankfurter and other sausages, sardine anchovies All fried, fatty or heavily marbled meat, poultry, or fish Dry beans and peas prepared with fat or high-fat meat Chunky peanut butter and nuts and seeds
FATS & SNACKS (use sparingly) Non fat or low-fat dressings and mayonnaise Mild low fat salad dressings Mildly flavored gravies and sauces Butter or margarine (preferably the light or low fat brands) Sugar, syrup, honey, jelly, seedless jam, hard candies, molasses, marshmallows Sherbet, fruit ice, gelatin, angel food cake, graham crackers, and nonfat desserts Pretzels (soft or hard), rice cakes	FATS & SNACKS Gravies, cream soups Highly seasoned salad dressings High-fat snacks such as chips, fried potatoes and buttered popcorn Cakes, cookies, pies, pastries, and doughnuts Coconut, chocolate, or creamed candy All sweets and desserts containing nuts, coconut or fruit not allowed
MISC. Salt, pepper, flavorings and most spices and herbs Ketchup, mustard and vinegar in moderation All beverages as tolerated	MISC. Carbonated beverages, coffee (regular or decaffeinated) Strongly flavored seasonings and condiments such as garlic, barbecue sauce, chili sauce, chili pepper, horseradish, black pepper, chili powder and other highly spiced foods Pickles Caffeine-containing beverages (coffee, tea, colas, orange soda) Alcoholic beverages Nicotine, aspirin and aspirin-containing medicines

Information Source Links

Graham DY et al. (1999). Recognizing peptic ulcer disease. Postgraduate Medicine 105:113,
Vander A et al. (2000). Human physiology: The mechanisms of body functions. 8^th ed. Boston: McGraw-Hill.