Definition

Peptic ulcer disease is damage to the lining of the stomach (gastric ulcer) or duodenum (duodenal ulcer), which then comes into contact with gastric acid secretions in the stomach or duodenum. It can also be found on the lining of the esophagus. The ulcer is characterized by a significant loss of substance from the internal gastric or duodenal mucous membrane wall, hollowing out this wall deep down to the muscular external layer.

Etiology

The etiology of peptic ulcer disease is multifactorial. It usually occurs when there is an imbalance between the aggressive agents and the protective factors of the digestive mucosa, as it then becomes more sensitive to acidity. Aggressive agents can be endogenous (internal), such as hydrochloric acid and pepsin which are secreted by the stomach, or exogenous (external), such as pathogenic bacteria (Helicobacter pylori), chemicals, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), stress, etc. Defense factors of the digestive lining include mucus, bicarbonate, blood flow, cellular tissue (epithelium), and prostaglandins, hormones found in the body. The most common causes of peptic ulcer disease are infection withHelicobacter pylori (H. pylori) and the use of NSAIDs.

Symptoms

The most common symptom of peptic ulcer disease is pain in the upper abdomen (epigastrium). This pain can sometimes be accompanied by nausea, vomiting and weight loss.

Medical treatment

Medical treatment for peptic ulcer disease may include the use of antibiotics to kill the bacteriaH. pylori, when that is the cause of the problem, and using drugs to decrease the secretion of acid into the stomach or duodenum. In rare cases, surgical treatment to reduce acid production may be used.

Nutritional approach

Studies do not show that a specific diet can promote healing or prevent recurrence of peptic ulcer disease. Thus, there is no specific therapeutic regimen for this disorder of the digestive tract. The goal of the nutritional approach is therefore to improve the well-being of the individual and to provide an adequate food intake, according to individual tolerance.

Dietary recommendations

As there is no specific therapeutic diet for peptic ulcer disease, the dietary recommendations consist of promoting a balanced and individualized diet according to individual problems, symptoms and intolerances to improve the comfort of the person. Dietary recommendations can include:

• Eat three meals a day andsnacks as needed, to avoid periods of prolonged fasting. Food usually helps ease symptoms of peptic ulcer disease, especially in duodenal ulcer.
• Consume an adequate amount of fiber (eg: fruits and vegetables, grain products).
• Moderate the consumption of foods containing methylxanthines (eg: coffee, chocolate, cocoa, cola), caffeine and alcohol.
• Consume spices according to individual tolerance.
• Stop smoking, as this slows down the healing process of ulcers and increases the risk of recurrence.

There is no specific treatment regimen for peptic ulcer disease. The food approach therefore does not cure or prevent the recurrence of this disease of the digestive tract. In the case of peptic ulcer disease, the nutritional approach is more aimed at promoting individual comfort and providing a balanced and individualized diet according to the tolerance of each person. Finally, the main dietary recommendation is generally to avoid foods that cause or worsen symptoms, tobacco and alcohol.

References

1. Bouthillier, Lise. January 2019. Diseases of the digestive tract. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
2. D’Aoust, Louise. January 2019. Pathophysiology of the digestive system. NUT 2047 Clinical nutrition 2. Montreal: University of Montreal.al.
3. https://www.merckmanuals.com/fr-ca/professional/troubles-gastro-intestinaux/gastrite-et-ulc%C3%A8re-gastroduod%C3%A9nal/ulc%C3%A8re-gastroduod%C3%A9nal
4. https://www.merckmanuals.com/fr-ca/accueil/troubles-digestifs/gastrite-et-ulc%C3%A8re-gastroduod%C3%A9nal/ulc%C3%A8re-gastroduod%C3%A9nalquery=Ulc% C3% A8re% 20gastroduod% C3% A9nall
5. https://www.merckmanuals.com/fr-ca/accueil/les-faits-en-bref-troubles-digestifs/gastrite-et-ulc%C3%A8re-gastroduod%C3%A9nal/ulc%C3%A8re- gastroduod% C3% A9nal

Article written by:

Marie-Noël Marsan, Nutritionist