Peptic Ulcer Disease

By: Hillary SullivanOhio University

NUTR 4100: Medical Nutrition Therapy IINovember 26, 2013

What is Peptic Ulcer Disease?

Disorder of the upper GI tract Definition: Damage or erosion of the lining of

the stomach or duodenum Mucosal lining breaks down, resulting in

acute or chronic inflammation 500,000 people are diagnosed each year

Types of ulcers 3 categories

Esophageal Gastric Duodenal

Signs and Symptoms Acute

Pain or discomfort in the abdomen

Bloating Heartburn Nausea or vomiting

Alert Bleeding Hemorrhaging Perforation Gastric outlet

obstruction Dark or black stool Weight loss

Etiology Helicobacter pylori infection (H. pylori):

#1 cause of PUD (92%) Transmitted from person to person, either

through oral or fecal matter, also through contaminated food or water

15% to 20% of individuals infected will actually develop PUD in their lifetime.

Significant decline of the overall rate for H. pylori infections

H.pylori Dr. Barry Marshall

and Dr. Robin Warren

Awarded the Nobel Prize for 1982 discovery of the H. pylori and its role in PUD

Etiology NSAIDs:

Non-steroidal anti-inflammatory drugs

Disrupt the mucosal lining, making the mucosa vulnerable to injury

Over the Counter NSAIDs include Aspirin, Ibuprofen, Naproxen

5x more likely to develop Low-dose aspirin

Etiology Lifestyle factors:

Smoking Harmful to the gastric mucosa H pylori population is denser in the gastric

cavity of smokers. Alcohol

Ethanol is known to cause gastric mucosal irritation

Foods High caffeine and spicy food irritate mucosal

lining

Etiology Physical stress:

Burns, CNS trauma, surgery, severe medical illness and traumatic injuries increase the risk for secondary ulceration

Genetic factors: 20% of patients have a family history

Age Most prevalent in elderly (>65) Use of NSAIDs

Pepsin and Hydrochloric acid

Diagnostic Tests Endoscopy Biopsy Upper GI X-Rays/ Barium

swallow test

Tests for H. pylori Breath test H. pylori culture, stool antigen test simple blood test.

Nutrition Diagnosis Nutrition diagnosis associated with PUD

Food and Nutrition related knowledge deficit (NB-1.1) Inadequate oral intake (NI-2.1) Excessive oral intake (NI-2.2) Undesirable food choices (NB -7.1)

Sample PES statement: Food and Nutrition related knowledge deficit (NB-1.1)

related to lack of prior exposure to reliable nutrition information as evidenced by statement of need to avoid raw fruits and vegetables with ulcer disease.

Increased nutrient needs (NI-5.1)related to altered GI function as evidenced by diagnosis of PUD, altered nutrition related lab values and frequent bloody stools.

Lab Values RBC

M: 4.5- 5.5x 106 /ml F: 4.0- 4.9x 106 /ml

Hematocrit M: 41 – 50% F: 36 – 44%

Stool occult blood test (-/+)

WBC: 4,500-10,000 mcL

Hemoglobin blood- Male: 13.5-17.5 g/dL Female: 12.0-16.0 g/d

Iron- 50-170 µ g/dL

Medications H. pylori infection- 1-2 weeks of antibiotics

Bismuth (the main ingredient in Pepto-Bismol) may be added to help kill the bacteria

Proton pump inhibitors (PPI) -4 weeks H2 blockers Mucosal protectants –Prilosec, Nexium,

Misoprostol Surgery

MNT Nutrition therapy will assist in the reduction or

elimination of symptoms and correction of nutrient deficiencies. Choose foods gentile on the stomach Avoid high caffeine and spicy foods Smaller, more frequent meals and avoid eating

before bedtime

food recall- focus on the patient’s consumption of food that could potentially increase gastric acidity or foods that the patient cannot tolerate

Intervention Goals Optimize nutritional intake to meet nutrient

needs Implement dietary and lifestyle factors that

will reduce symptoms, decrease pain, and promote healing

Sample Treatment Menu Breakfast:

2 cups whole grain cereal 1 cups skim milk 1 banana 1 cup herbal tea

Snack 12 Whole wheat crackers 2 oz. low fat cheese

Lunch Turkey spinich wrap 1 cup low fat yogurt 1 medium apple

Snack 1 cup carrots 2 tbsp hummus

Diner 6 oz. baked Tilapia 1 cup whole wheat rice I cup steamed broccoli 1 cup skim milk

Rational: No high caffeine

foods No spicy foods Frequent meals Food easy on the

stomach

Sources Academy of Nutrition and Dietetics (AND). Peptic Ulcers:

Nutrition Care Manual. 2013. Ramakrishnam K, Salinas R, Peptic Ulcer Disease.

American Family Physician, 2007; 1;76(7):1005-1012. Feinstein L, Holman R, Yorita Christensen K, Steiner C,

Swerdlow D. Trends in Hospitalizations for Peptic Ulcer Disease, United States, 1998–2005. Emerging Infectious Diseases.2010;16(9).

Adams P, Marshall B. Helicobacter pylori: A Nobel pursuit? Canadian Journal of Gastroenterology, 2008. 22(11): 895–896.

Elsevier. Peptic Ulcer Disease. Clinical Key. 2012