STOMACH ULCERS

ROLE OF NUTRITION IN TREATMENT AND PREVENTION OF STOMACH ULCERS.

OBJECTIVES

§    At the end of this presentation students should know the meaning of stomach  ulcers

§    Should know the causes of stomach ulcers

§     Should know the dietary requirement for a person with stomach ulcers

§     Drugs-nutrients interaction on stomach ulcers

§     Prevention of stomach ulcers

       INTRODUCTION

   For decades, doctors have recommended dietary adjustments aimed at preventing or treating symptoms of peptic ulcers . Common suggestions have included avoiding spicy foods, coffee, and alcohol, and increasing consumption of bland foods and milk. while these suggestions seem reasonable, some have not stood up well in controlled investigations.

   For-example, milk ingestion tends to increase gastric acid secretion. Although certain spices (black pepper, chili powder, red pepper) may cause dyspepsia, they have not been shown to contribute to either gastritis or peptic ulcer.

   Ulcers is approximately 10% globally,as of 2010,approximately 250,000 people died of peptic ulcers diseases down from 320,000 in 1990. in western countries the prevalence of helicobacter pylori infections roughly matches (i.e 20% at age 20, 30% at age 30, 80% at age 80) prevelence is higher in third world

 ●Countries where it is estimated at about 70% of the population, where a developed countries shows a maximum of 40% ratio

 STOMACH ULCERS

Definition of a stomach ulcer refers to painful sores in the lining of the stomach or first part of the small intestine(duodenum),

                    Types of stomach ulcers

●Gastric ulcers is the hole in the lining of the stomach corroded by the acidic digestive juice which are secreted by the stomach cells

● Duodenal ulcers, a crater(sore) in the lining of the beginning of the small intestine.

●Esophageal ulcers ulcers that develop inside the esophag section, 

 Esophageal ulcers can be caused by GERD (gastro esophageal reflux diseases) this is the condition that occurs when acid from the stomach flows back into the esophagus.

●An ulcer in the lining of the stomach(gastric ulcer) and duodenum(duodenal ulcer) all together are known as a peptic ulcer(stomach ulcers) 

 Esophageal ulcers can be caused by GERD (gastro esophageal reflux diseases) this is the condition that occurs when acid from the stomach flows back into the esophagus.

●An ulcer in the lining of the stomach(gastric ulcer) and duodenum(duodenal ulcer) all together are known as a peptic ulcer(stomach ulcers) 

 ●Patient with peptic ulcers

CAUSES OF STOMACH ULCERS

●Helicobacter pylori; most ulcers develop as a result of infection from the bacterium Helicobacter pylori(H.pylori). The bacteria produces toxins that weaken the stomach's protective mucus and make it more susceptible to the damaging effects of acid and pepsin.

PEOPLE AT RISK WITH STOMACH ULCERS

●People with physical stress;this may increase the risk of developing ulcers, particularly in the stomach. For example, people with injuries, such as severe burns, and people undergoing major surgery treatment to prevent ulcers and ulcer related complications , such as bleeding

● Smoking people; this increases the chance of developing an ulcer, slows the healing process of existing ulcers, and contribute to ulcers  recurring.

 Use of Caffein;Caffein seems to stimulate acid secretion in the stomach, which can give aggravate the pain of an existing ulcer. However, the stimulation of stomach acid can not be attributed solely to caffeine.

People consuming Alcohol; Although no proven link has been found between alcohol consumption and peptic ulcers, ulcers are more common in people who have cirrosis of the liver, a disease often linked to heavy alcohol consumption.

● Productions of acid and pepsin;it is believed the stomach's inability to defend itself against the powerful digestive fluids, hydrochloric acid and pepsin, contribute to ulcer formation which caused either by stress or staying for a long time with stomach empty

● People who regularly takes non steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, aspirin, or naproxen.

●People with a family history of ulcers

●People who have illness or diseases associated with the liver, kidney, and lung. People older than 50 years of age.

DIETARY REQUIREMENT FOR A      PATIENT WITH STOMACH
ULCERS

High–fiber diets. A large cohort study at the Harvard School of Public Health found that high–fiber diets were associated with reduced risk for developing gastric ulcer. Over a 6–year period, the risk was 45% lower for those with the highest fiber intake, compared with those with the lowest.

Food sources of soluble fiber ( legumes, barley, certain fruits and vegetables) were especially protective, resulting in a 60% lower risk for this group. However, supplementation with dietary fiber will reduce the risk.

Green tea. Several studies show that regular green tea consumption is associated with a 40% to 50% lower risk for gastritis. Cellular tests suggest that the catechins in green tea (eg, epigallocatechin–3–gallate, EGCG)

This may suppress H pylori–induced gastritis through antioxidant and antibacterial actions. However, current evidence is not yet sufficient for recommending green tea for prevention of gastritis.

Fat should be used in moderate amounts.

Emulsified fats like butter, cream etc. are

better tolerated.

Energy: patients suffering from peptic ulcers are undernourished and therefore, need an increased energy intake. In case of patients at bed rest, the energy needs for activity are not utilized and makeup the extra needs so energy dense foods must be maintained

Diets high in vitamins' total vitamin A intake (from food and supplements) is associated with lower risk. The risk is 54% lower among persons consuming the most vitamin A, compared with those consuming the least, other vitamins  which helps in treatment of ulcers includes vitamin E and vitamin K  .

DIET SAMPLE FOR A PERSON WITH ULCERS

                            BREAKFAST

●Apple juice a 1/2 cup

●Skim milk 1 cup margarine 1tsp or soy milk

●Sugar 1 tsp

●Fruits like banana and peaches

●Whole grains

LUNCH
●Cream of potato soup ¾ cup
●Skim milk 1 cup
●Salt ¼ tsp
●Low fat dressing foods
●Eating foods such as eggs and
mashed potatoes,vegetables
contains vitamins, minerals,
antioxidant and soluble fibres.
DRUGS-NUTRIENT
INTERACTION
OMEPRAZOLE
Interactions with Nutritional
Supplements
Folic acid. Folic acid is needed by
the body to utilize vitamin B12.
Antacids, including Omeprazole,
inhibit folic acid absorption.
Those taking antacids are
advised to supplement with folic 
acid.

DINNER
●Mashed potatoes
●Green beans ½ cup
●Bread 1 slice
●Margarine 1 tsp
●Salt ¼ tsp
●Brown rice
Vitamin B12. Omeprazole
interferes with the absorption of
vitamin B12 from food (though
not from supplements) in some
studies. The fall in vitamin B12
status may result from the
decrease in stomach acid
required for vitamin B12
absorption from food, caused by
the drug. However, all those
taking Omeprazole need to
either supplement with vitamin
B12.
Ranitidine Also indexed as:
Zantac®

Interactions with Nutritional
Supplements

Folic acid Folic acid is needed by
the body to utilize vitamin B12.
Antacids, including ranitidine,
inhibit folic acid absorption.
Those taking antacids are
advised to supplement with folic
acid.

Iron Stomach acid may facilitate
iron absorption. Ranitidine
reduces stomach acid and is
associated with decreased
dietary iron
absorption.Magnesium In
healthy volunteers, a magnesiu
antacid, taken with ranitidine,
decreased ranitidine absorption
by 20%–25%. This interaction
can be avoided by taking
ranitidine two hours before or
after any magnesium-containing
antacids, including magnesium in
vitamin/mineral supplements.

Vitamin B12 Stomach acid is
needed to release vitamin B12
from food so it can be absorbed
by the body. Ranitidine reduces
stomach acid and is associated
with decreased dietary vitamin
B12 absorption. The vitamin B12
found in supplements is available
to the body without the need for
stomach acid.

TAKE HOME MESSAGE
ON  STOMACH PREVENTION

●Eating a health diet rich in
fruits, vegetables, and whole
grains
●Not mixing alcohol with
medication
●Wash your hand frequentry to
prevent infections
●Limiting use of Nonsteroidal
Anti-Inflammatory Drugs
(NSAIDs) like aspirin and
ibuprofen   
●Eat three meals daily, avoid
skipping meals and limit your
intake of spice, fatty or other
foods that cause discomfort.
●Avoid bedtime snacks since
symptoms occur in the night
●Limit your alcohol intake and
avoid taking in an empty
stomach.

REFERENCES
Vemulapalli, R. (2008) diet
and life style modifications in
the management of stomach
ulcers disease, Nutrition in
Clinical Practice, 23, 293 –
298.
Ryan harshman, M. Aldoor,
(2004, how diet style affect
duodenal ulcers Canadian
family physician, 50, 727 –
732.
Harbison, S. & Dempsey, D.
(2005). Peptic ulcer disease,
current problem in surgery,
42, 346 – 454.
Holtman, D. Adam, B, libregts,
T, (2004) reviwe article. The
patient with stomach ulcers
almentary pharmacology.