Peptic Ulcer is a chronic ulcer formed in regions of the gastrointestinal tract where gastric juice comes in direct contact with mucous membrane. Such ulcers usually occur in the first part of the duodenum and in the stomach. They sometimes occur in the lower Esophagus; in the jejunum after gastro-enterostomy.
Peptic Ulcers can occur at any age but the incidence is highest in middle adulthood between the ages of 45 to 55 years.
Ulcers occur more often in men than in women.
It may occur in combination with other diseases such as rheumatoid arthritis or other stressful illnesses or injuries.
In patients with duodenal ulcers, hyper secretion of acid is the primary causative factor while in gastric ulcers, it is the weakened mucosal resistance to acid which causes ulcers.
The immediate objectives of dietary treatment are
- To provide adequate nutrition
- To afford rest
- To maintain continuous neutralization of gastric acid
- To minimize acid secretions
- To reduce mechanical, thermal and chemical irritation to the gastric mucosa
To achieve these dietary objectives, following nutrient modifications are recommended
Most patients suffering from active peptic ulcers are undernourished and therefore need an increased energy intake. However, since they are confined to bed the energy needs for activity are not utilized and make up the extra needs.
A high protein intake is recommended to provide essential amino acids for tissue protein synthesis and thus promote healing. Proteins are also included because of their good buffering action. They may be increased by about 50 %. However meat proteins are to be avoided because meat extractives have a stimulating effect.
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Though milk protein has a good buffering action, the high calcium content of milk stimulates excess acid production. Therefore, a high milk intake has an adverse effect on the healing rate of ulcers. Thus milk should be used in moderation. Eggs and other protein foods need to be included to provide essential amino acids.
Since fat delays the emptying of stomach, an increased intake is beneficial. However, fat is only moderately increased since patients suffering from peptic ulcers are generally middle aged executives who are also prone to atherosclerosis. Emulsified fats like butter, cream etc are better tolerated.
Carbohydrates are included to meet the energy needs. Foods containing harsh, irritating fiber should be avoided.
Requirements of nearly all vitamins remain normal. adequate amount of vitamin C should be provided for the healing of ulcers and better iron absorption.
Care should be taken to include sources of iron and calcium in the diet. Generally, blend diets are found to be low in iron and vitamin C due to the restriction in fruits and vegetables and medicinal supplements may have to be given.