Understanding Peptic Ulcers: Causes, Symptoms, and Dietary Management

1. PEPTIC ULCER

2. PEPTIC ULCER The term peptic ulcer is used to describe any localised erosion of the mucosal lining of those portions of the alimentary tract that come in contact with gastric juice. This disintegration of tissues can also result in necrosis. The majority of ulcers are found in the duodenum, although they also occur in the oesophagus, stomach or jejunum.

3. Mechanism of Ulcer formation The three vital mechanisms are the mucous layer, prostaglandins and probably the 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.

4.  The mucous layer, viscous gel ideally suited for its function of protection from chemical and physical hazards of water proofing and lubrication.  The second line of defence are prostaglandins.It is a mechanism which enables the gastric mucosa to withstand even absolute alcohol and boiling water and to counter a wide variety of chemical hazards even without any help from simultaneous reduction of gastric acid secretion.

5.  Urogastrone (third line of defence) 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.

6. Factors  The factors that influence mucosal ability to withstand destructive action are: (1) the integrity of mucosal cells; (2) the ability of epithelial cells to regenerate themselves; (3) the mucosal barrier and (4) the blood supply: Various topical irritants impair this tissue, including aspirin, alcohol, certain drugs, caffeine or bile acids that may come contact with the mucosa.

7. Symptoms  Discomfort and flatulence in upper part of abdomen. The basis for pain may be the action of unneutralised hydrochloric acid on exposed nerve fibres at the site of ulcer.  Pain is also associated with hypermotility of the stomach or gastric distension following ingestion of large amounts of food or liquids.  Weight loss and iron deficiency anaemia are common.

8.  Bleeding ulcers can result in vomiting known as haematemesis (dark brown in colour).  There are spasms of pyloric canal and this may give rise to a feeling of sickness distension, and prevent taking food.

9. Diagnosis  Radiographic examination with Barium Meat: The technique, 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 detect any breaks in the lining membrane It takes 15-20 minutes. If there is cancer, it can also be detected by endoscope.

10. Biopsy: Biopsy of lining tissue is done. Acid secretion of the stomach: In this the acid output after stimulation by pentagastrin is measured. It is useful for further investigation if surgery is contemplated. Acid output is higher than normal in duodenal ulcer and low or absent in patients with carcinoma of the stomach

11. Dietary Management  It Was customary to suggest bland diet for ulcer patients Bland diet is a diet which is mechanically, chemically and thennally non- irritating.  Bland diet prevents irritation to the macosa, avoids increase in acidity and aids in control of pain.

12.  Protein - Milk should be included as a source of factors for healing purposes. Protein provides the necessary amino acids for synthesis e protein which helps in healing ulcer.  Fats- Fats such as cream, butter and olive oil can be particularly helpful in thin patient. Fried foods are not advised as they are difficult to digest and often aggravate the symptoms.

13.  Ascorbic acid – Hence citrus fruit juice and tomato juice can be given. The pH of food before ingestion has little significance. No food is sufficiently acid by itself to effect a significant pH change or cause direct imitation on an ulcer.  Gasformers - In addition, certain foods traditionally forbidden include strongly favoured vegables such as cabbage, cauliflower, onions and tumips and fried foods. Restriction of these foods is based on subjective evidence from patients who experience distress following ingestion of these items Large meals are avoided.

14.  Fibre - A regular diet, including good food sources of dietary fibre, has proved to be beneficial.  Potentially irritant substances – Chillies, pepper, ginger. Garam masala, meat soups and strong tea or coffee and protein rich foods increase the secretion of hydrochloric acid and aggravate the condition

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