1. Peptic Ulcer Disease Diet Therapy

Overview A peptic ulcer is a sore in the lining of the stomach or first part of the small intestine called the duodenum. When an individual has chronic peptic ulcers, it is known as peptic ulcer disease (PUD). A healthy digestive tract is coated with a layer of mucus that protects against acid deterioration. If the mucus decreases or the acid increases, an ulcer can result. Some ulcers may be associated with infection from a bacterium called Helicobacter Pylori (H.

Study Diet and Nutrition Final TB 19 & 20. Which of the following diet modifications should the nurse request? Surgery for peptic ulcer cures the disease with. In this era of H2-inhibitors, the available evidence does not support the need to place peptic ulcer disease patients on restrictive diets. The major goal of diet is to avoid extreme elevations of gastric acid secretion and the direct irritation of gastric mucosa. In view of this, only slight modifications in the patient's usual diet are recommended.

Pylori can live in the mucus layer and often causes no problems, but sometimes the bacterium can cause inflammation in the stomach lining and slowly produce an ulcer. Pylori can be transmitted through food, water, and close human contact. Another cause of PUD is long-term use of anti-inflammatory medicines like aspirin and ibuprofen. And contrary to popular belief, while stress and spicy foods can aggravate ulcers, they do not cause them. If untreated, peptic ulcers may get worse and cause more serious problems. Symptoms of PUD Burning stomach pain is the most common symptom of peptic ulcers and may come and go for a few days or weeks.

Pain is more bothersome when the stomach is empty and usually recedes after the patient eats. The burning sensation may become worse at night and is almost always worse on an empty stomach. Sometimes, peptic ulcer disease has more severe symptoms. Nausea. Vomiting of blood—Blood may appear red or black. Unexplained weight loss.

Loss of appetite. Dark blood in the stools or tar-like stools Risk Factors for PUD.

Alcohol—Alcohol can wear away the mucus lining of the stomach and gut, and it also increases the amount of stomach acid that is produced. Smoking—Smoking can increase the risk of peptic ulcers for those who are infected with H. Long-term use of pain relievers and/or nonsteroidal anti-inflammatory drugs (NSAIDs). Tests to Diagnose PUD. H. Pylori test- Doctors can test for the presence of H. Pylori in the system by a blood sample, stool sample or a breath test.

It can also be diagnosed by obtaining a sample of tissue during endoscopy. Endoscopy- an endoscopy is a test that uses a hollow tube with a lens attached. The scope can view the throat, stomach and small intestine and detect an ulcer. Biopsy- if an ulcer is found, a small tissue sample will be removed and examined. X-ray- Swallowing barium (a white liquid) before the x-ray helps doctors see details of the esophagus, stomach, and small intestine as well as view the ulcer Treatments for PUD Depending on the cause of the peptic ulcer, treatments will vary. Antibiotics—antibiotics can kill the bacterium H.

Pylori in the digestive system. A two-week treatment should be sufficient, and then antacid medication may be prescribed to control stomach acid. Proton pump inhibitors—these medications reduce stomach acid by blocking the action of cells that produce acid. Examples of brand-name proton pump inhibitors are Prilosec, Prevacid, Aciphex, Nexium and Protonix. H2 blockers—these medications reduce stomach acid, reduce pain and bring healing.

Brand-name products are Zantac, Pepcid, Tagamet, and Axid. Antacids—these medications neutralize stomach acid. Side effects can include constipation or diarrhea. Antacids relieve symptoms but do not always produce healing. If medication does not heal a peptic ulcer, this may be an indication of another issue. An infection other than H. Pylori.

Zollinger-Ellison syndrome—extreme overproduction of gastric acid. Stomach cancer. Crohn’s disease Lifestyle Changes to Treat PUD Along with medication, these lifestyle changes may be helpful in assisting to control the pain of peptic ulcer disease.

Wise diet choices—eating plenty of fresh fruits, vegetables and whole grains may promote healing. Processed foods, fried foods and junk food will make it harder to heal. Change your pain reliever—because PUD can be aggravated by using certain pain relievers, talk to your doctor about a different option. Stop smoking—Smoking can affect the mucus lining of the stomach and produce more stomach acid. Avoid alcohol—Alcohol can wear away the mucus layer of the stomach and intestine. Manage stress—Use exercise, mediation, relaxation techniques and recreation to reduce stress and reduce stomach acid production.

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Endoscopy An endoscopy procedure involves inserting a long, flexible tube (endoscope) down your throat and into your esophagus. A tiny camera on the end of the endoscope lets your doctor examine your esophagus, stomach and the beginning of your small intestine (duodenum). In order to detect an ulcer, your doctor may first take a medical history and perform a physical exam. You then may need to undergo diagnostic tests, such as:. Laboratory tests for H. Your doctor may recommend tests to determine whether the bacterium H.

Pylori is present in your body. He or she may look for H. Pylori using a blood, stool or breath test. The breath test is the most accurate. Blood tests are generally inaccurate and should not be routinely used. For the breath test, you drink or eat something containing radioactive carbon. Pylori breaks down the substance in your stomach.

Later, you blow into a bag, which is then sealed. If you're infected with H. Pylori, your breath sample will contain the radioactive carbon in the form of carbon dioxide. If you are taking an antacid prior to the testing for H. Pylori, make sure to let your doctor know. Depending on which test is used, you may need to discontinue the medication for a period of time because antacids can lead to false-negative results. Your doctor may use a scope to examine your upper digestive system (endoscopy).

During endoscopy, your doctor passes a hollow tube equipped with a lens (endoscope) down your throat and into your esophagus, stomach and small intestine. Using the endoscope, your doctor looks for ulcers. If your doctor detects an ulcer, small tissue samples (biopsy) may be removed for examination in a lab. A biopsy can also identify whether H. Pylori is in your stomach lining. Your doctor is more likely to recommend endoscopy if you are older, have signs of bleeding, or have experienced recent weight loss or difficulty eating and swallowing.

If the endoscopy shows an ulcer in your stomach, a follow-up endoscopy should be performed after treatment to show that it has healed, even if your symptoms improve. Upper gastrointestinal series. Sometimes called a barium swallow, this series of X-rays of your upper digestive system creates images of your esophagus, stomach and small intestine. During the X-ray, you swallow a white liquid (containing barium) that coats your digestive tract and makes an ulcer more visible.

Treatment Treatment for peptic ulcers depends on the cause. Usually treatment will involve killing the H. Pylori bacterium, if present, eliminating or reducing use of aspirin and similar pain medications, if possible, and helping your ulcer to heal with medication. Medications can include:. Antibiotic medications to kill H. Pylori is found in your digestive tract, your doctor may recommend a combination of antibiotics to kill the bacterium. These may include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), tinidazole (Tindamax), tetracycline (Tetracycline HCL) and levofloxacin (Levaquin).

The antibiotics used will be determined by where you live and current antibiotic resistance rates. You'll likely need to take antibiotics for two weeks, as well as additional medications to reduce stomach acid, including a proton pump inhibitor and possibly bismuth subsalicylate (Pepto-Bismol). Medications that block acid production and promote healing.

Proton pump inhibitors — also called PPIs — reduce stomach acid by blocking the action of the parts of cells that produce acid. These drugs include the prescription and over-the-counter medications omeprazole (Prilosec), lansoprazole (Prevacid), rabeprazole (Aciphex), esomeprazole (Nexium) and pantoprazole (Protonix). Long-term use of proton pump inhibitors, particularly at high doses, may increase your risk of hip, wrist and spine fracture. Ask your doctor whether a calcium supplement may reduce this risk. Medications to reduce acid production. Acid blockers — also called histamine (H-2) blockers — reduce the amount of stomach acid released into your digestive tract, which relieves ulcer pain and encourages healing.

Available by prescription or over-the-counter, acid blockers include the medications ranitidine (Zantac), famotidine (Pepcid), cimetidine (Tagamet HB) and nizatidine (Axid AR). Antacids that neutralize stomach acid. Your doctor may include an antacid in your drug regimen. Antacids neutralize existing stomach acid and can provide rapid pain relief. Side effects can include constipation or diarrhea, depending on the main ingredients. Antacids can provide symptom relief, but generally aren't used to heal your ulcer. Medications that protect the lining of your stomach and small intestine.

In some cases, your doctor may prescribe medications called cytoprotective agents that help protect the tissues that line your stomach and small intestine. Options include the prescription medications sucralfate (Carafate) and misoprostol (Cytotec).

Follow-up after initial treatment Treatment for peptic ulcers is often successful, leading to ulcer healing. But if your symptoms are severe or if they continue despite treatment, your doctor may recommend endoscopy to rule out other possible causes for your symptoms. If an ulcer is detected during endoscopy, your doctor may recommend another endoscopy after your treatment to make sure your ulcer has healed. Ask your doctor whether you should undergo follow-up tests after your treatment. Ulcers that fail to heal Peptic ulcers that don't heal with treatment are called refractory ulcers. There are many reasons why an ulcer may fail to heal, including:. Not taking medications according to directions.

The fact that some types of H. Pylori are resistant to antibiotics.

Regular use of tobacco. Regular use of pain relievers — including aspirin, ibuprofen (Advil, Motrin, others) and naproxen sodium (Aleve, Anaprox, others) — that increase the risk of ulcers Less often, refractory ulcers may be a result of:. Extreme overproduction of stomach acid, such as occurs in Zollinger-Ellison syndrome. An infection other than H. Pylori. Stomach cancer.

Other diseases that may cause ulcer-like sores in the stomach and small intestine, such as Crohn's disease Treatment for refractory ulcers generally involves eliminating factors that may interfere with healing, along with using different antibiotics. If you have a serious complication from an ulcer, such as acute bleeding or a perforation, you may require surgery. However, surgery is needed far less often than previously because of the many effective medications now available.

Lifestyle and home remedies You may find relief from the pain of a stomach ulcer if you:. Choose a healthy diet. Choose a healthy diet full of fruits, especially with vitamins A and C, vegetables, and whole grains. Not eating vitamin-rich foods may make it difficult for your body to heal your ulcer.

Consider foods containing probiotics. These include yogurt, aged cheeses, miso, and sauerkraut. Consider eliminating milk. Sometimes drinking milk will make your ulcer pain better, but then later cause excess acid, which increases pain. Talk to your doctor about drinking milk. Consider switching pain relievers.

If you use pain relievers regularly, ask your doctor whether acetaminophen (Tylenol, others) may be an option for you. Control stress. Stress may worsen the signs and symptoms of a peptic ulcer. Consider the sources of your stress and do what you can to address the causes. Some stress is unavoidable, but you can learn to cope with stress with exercise, spending time with friends or writing in a journal. Don't smoke. Smoking may interfere with the protective lining of the stomach, making your stomach more susceptible to the development of an ulcer.

Smoking also increases stomach acid. Limit or avoid alcohol. Excessive use of alcohol can irritate and erode the mucous lining in your stomach and intestines, causing inflammation and bleeding. Try to get enough sleep.

Sleep can help your immune system, and therefore counter stress. Also, avoid eating shortly before bedtime. Alternative medicine Over-the-counter medications that contain calcium carbonate (Tums, Rolaids), may help treat peptic ulcers but should not be used as the primary treatment. There is also some evidence that zinc can help heal ulcers. Among botanicals recommended to treat peptic ulcers are turmeric, mastic, cabbage, deglycyrrhizinated licorice, and neem bark extract. While over-the-counter and alternative medications may be helpful, evidence on effectiveness is lacking.

Therefore they are not recommended as the primary treatment for peptic ulcers. Preparing for your appointment Make an appointment with your regular doctor if you have signs or symptoms that worry you. Your doctor may refer you to a specialist in the digestive system (gastroenterologist). It's a good idea to be well-prepared for your appointment. Here's some information to help you get ready, and what you can expect from your doctor.

What you can do. Be aware of any pre-appointment restrictions. At the time you make the appointment, ask if there's anything you need to do in advance, such as restrict your diet. Certain medications can affect peptic ulcer tests, so your doctor may want you to stop taking them.

He or she may be able to suggest alternatives to these drugs. Write down any symptoms you're experiencing, as well as the food you're eating. People with peptic ulcers often experience more symptoms when their stomachs are empty. Write down key personal information, including any other medical problems, major stresses or recent life changes. Make a list of all medications, including over-the-counter medications, vitamins or supplements that you're taking.

It's especially important to note any pain reliever use and the usual dose that you take. Write down questions to ask your doctor.

For peptic ulcers, some questions you might want to ask your doctor include:. What's the most likely cause of my symptoms?. What kinds of tests do I need, and how do I need to prepare for them?. Is my condition likely temporary or chronic?. Am I at risk of complications related to this condition?. What treatment do you recommend?. If the initial treatment doesn't work, what will you recommend next?.

Are there any dietary restrictions that I need to follow?. I have other medical problems. How can I manage these along with ulcers?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask other questions during your appointment. What to expect from your doctor Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over points you want to cover. Your doctor may ask:. When did you first begin experiencing symptoms?.

Have your symptoms been continuous or intermittent?. How severe are your symptoms?. Are your symptoms worse when you're hungry?. What, if anything, have you been taking to relieve your symptoms?. Does anything seem to improve your symptoms?.

What, if anything, appears to worsen your symptoms?. Do you take pain relievers or aspirin? If yes, how often?. Do you feel nauseated or have you been vomiting?. Have you ever vomited blood or black material?. Have you noticed blood in your stool or black stools?

What you can do in the meantime While you're waiting to see your doctor, avoiding tobacco, alcohol, spicy foods and stress may help lessen your discomfort. Feldman M, et al. Peptic ulcer disease. In: Sleisenger and Fordtran's Gastrointestinal and Liver Disease: Pathophysiology, Diagnosis, Management. Philadelphia, Pa.: Saunders Elsevier; 2016. Accessed June 6, 2016. AllScripts EPSi. Rochester, Minn.

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Peptic Ulcer Disease Diet Therapy

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