4.3 Nutrition Therapy for Peptic Ulcer Disease

Peptic ulcers are painful sores in the stomach or small intestine. They're caused by too much stomach acid, H. pylori bacteria, or NSAIDs. Left untreated, they can lead to serious complications like bleeding or perforation.

Treatment involves medications to reduce acid and kill bacteria. Diet changes help too. Avoiding irritants like spicy foods and eating smaller meals can soothe symptoms. Probiotics and nutrients like zinc may speed up healing.

Peptic Ulcer Pathophysiology

Causes and Mechanisms of Peptic Ulcers

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• Peptic ulcers form when stomach acid erodes the lining of the digestive tract, creating open sores in the stomach or duodenum
• Helicobacter pylori bacteria infect the stomach lining, weakening its protective mucus layer and increasing acid production
• Gastric acid overproduction overwhelms the stomach's natural defenses, leading to tissue damage and ulcer formation
• NSAIDs (Aspirin, Ibuprofen) reduce protective prostaglandins in the stomach, making the lining more susceptible to acid damage
• Gastritis involves inflammation of the stomach lining, increasing vulnerability to ulcer development
  • Acute gastritis occurs suddenly and can be caused by alcohol, stress, or certain medications
  • Chronic gastritis develops over time and is often associated with H. pylori infection

Risk Factors and Complications

• Smoking increases stomach acid production and impairs healing of the stomach lining
• Excessive alcohol consumption irritates and erodes the mucous lining of the stomach
• Stress can increase stomach acid production and decrease blood flow to the stomach
• Complications of untreated peptic ulcers include:
  • Internal bleeding
  • Perforation of the stomach or small intestine
  • Gastric outlet obstruction

Types of Peptic Ulcers

Duodenal Ulcers

• Occur in the first part of the small intestine (duodenum)
• More common than gastric ulcers, accounting for about 80% of peptic ulcers
• Often associated with increased acid production
• Symptoms typically worsen when the stomach is empty and improve after eating
• Pain is often described as burning or gnawing, located in the upper middle part of the abdomen

Gastric Ulcers

• Develop in the lining of the stomach
• Less common than duodenal ulcers but potentially more serious
• Often associated with reduced protective factors in the stomach lining
• Symptoms may worsen shortly after eating
• Can be associated with gastric cancer in some cases, requiring careful monitoring and follow-up
• Pain is typically located in the upper left part of the abdomen

Pharmacological Treatments

Acid-Reducing Medications

• Antacids neutralize existing stomach acid to provide quick relief from symptoms
  • Work by increasing the pH of the stomach contents (Calcium carbonate, Magnesium hydroxide)
  • Provide temporary relief but do not address the underlying cause of ulcers
• Proton pump inhibitors (PPIs) block acid production by inhibiting the proton pump in gastric parietal cells
  • Highly effective in reducing acid secretion (Omeprazole, Esomeprazole)
  • Used for both treatment and prevention of peptic ulcers
  • Can lead to long-term side effects if used extensively (nutrient malabsorption, increased risk of infections)
• H2 receptor antagonists block histamine receptors in the stomach, reducing acid production
  • Less potent than PPIs but still effective for many patients (Ranitidine, Famotidine)
  • Fewer side effects compared to PPIs, making them suitable for long-term use in some cases

Antibiotics and Cytoprotective Agents

• Triple therapy combines two antibiotics with a PPI to eradicate H. pylori infection
  • Typically includes clarithromycin, amoxicillin, and a PPI (Omeprazole)
  • Treatment duration usually lasts 7-14 days
• Bismuth subsalicylate acts as a protective coating for the ulcer and has antimicrobial properties
  • Often used in quadruple therapy for H. pylori eradication
  • Can cause temporary darkening of the tongue and stool

Nutritional Therapy

Dietary Modifications and Restrictions

• Dietary modifications aim to reduce irritation and promote healing of the ulcerated area
  • Avoid foods that increase stomach acid production (Caffeine, alcohol, spicy foods)
  • Consume smaller, more frequent meals to prevent excessive acid accumulation
  • Incorporate foods rich in flavonoids (Berries, apples, legumes) to support stomach lining health
• Probiotics introduce beneficial bacteria to the digestive system
  • Help restore balance to the gut microbiome, potentially inhibiting H. pylori growth
  • Can be consumed through fermented foods (Yogurt, kefir, sauerkraut) or supplements
  • May enhance the effectiveness of antibiotic treatment for H. pylori

Micronutrient Support for Healing

• Zinc plays a crucial role in wound healing and maintaining the integrity of the gastrointestinal lining
  • Supports the production of stomach acid and enzymes necessary for proper digestion
  • Found in high concentrations in oysters, beef, and pumpkin seeds
  • Supplementation may accelerate ulcer healing, especially in zinc-deficient individuals
• Vitamin A contributes to the maintenance and repair of epithelial tissues, including the stomach lining
  • Supports the production of mucus, which protects the stomach from acid damage
  • Found in both animal sources (Liver, eggs) and plant sources (Sweet potatoes, carrots)
  • Adequate intake is essential for optimal healing of peptic ulcers