Gastroduodenal Peptic Ulcer

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Before talking of ulcer and diet that we

have to be taken, it's a right way tospeak and describe the organs involvedin this disease:

- The Stomach - The Duodenum



The Stomach

The stomach is a muscular,

hollow, dilated part of the

alimentary canal which

functions as an importantorgan of the digestive tract. It

is involved in the second

phase of digestion, following

mastication (chewing). Thestomach is located between

the oesophagus and the small

intestine.



mucosa

The first main layer. This consists of the epithelium and the lamina propria

(composed of loose connective tissue), with a thin layer of smooth muscle

called the muscularis mucosae separating it from the submucosa beneath.

submucosa

This layer lies over the mucosa and consists of fibrous connective tissue,separating the mucosa from the next layer. The Meissner's plexus is in this

layer.

muscularis externa

Over the submucosa, the muscularis externa in the stomach has three layers

of smooth muscle

inner oblique layer

middle circular layer

outer longitudinal layer

serosa

This layer is over the muscularis externa, consisting of layers of connective

tissue continuous with the peritoneum.

The Stomach wall

The stomach walls are made of the following layers, from inside to outside



Glands of Stomach

Cardiac glands

(at cardia)

Pyloric glands

(at pylorus)

Fundic glands

(at fundus)

The epithelium of the stomach forms deep pits. The glands at these

locations are named for the corresponding part of the stomach:



The Stomach Glands Cell and their

Secretions

Layer of stomach Name Secretion Region of stomach

Isthmus of gland Mucous and mucoid

cells

mucus gel layer Fundic, cardiac, pyloric

Body of gland parietal (oxyntic)

cells

gastric acid and

intrinsic factor

Fundic, cardiac, pyloric

Base of gland chief (zymogenic)

cells

pepsinogen Fundic only

Base of gland enteroendocrine(APUD) cells

hormones gastrin,histamine,

endorphins,

serotonin,

cholecystokinin and

somatostatin

Fundic, cardiac, pyloric

Different types of cells are found at the different layers of these glands:



GASTRIC Juice

Hydrochloric acid

PepsinIntrinsic factor

1.1. Mucosal cellsMucosal cells

2.2. MucoidMucoid cellscells

3.3. Parietal cellsParietal cells4.4. Chief cellChief cell

GASTRICGASTRIC

GLANDGLAND



The Duodenum

The duodenum is the first

section of the small intestine.

The duodenum precedes the jejunum and ileum and is the

shortest part of the small

intestine, where most chemical

digestion takes place.

In humans, the duodenum is ahollow jointed tube about 1012 inch long connecting the

stomach to the jejunum. It begins with the duodenal bulb and

ends at the ligament of Treitz.



Duodenum parts

First part (superior) begins as a continuation of theduodenal end of the pylorus. Then 5cm

it curves inferiorly into the superior

duodenal flexure (the end of the

superior part).

Second part (descending) begins at the superior duodenal

flexure. At the end turn medially into

the inferior duodenal flexure (the end

of the descending part).

Third part (inferior/horizontal) begins at the inferior duodenal flexure

and passes transversely to the left,

crossing the right ureter.

Fourth part (ascending) reaches the inferior border of the body

of the pancreas. Then, it curves

anteriorly and terminates at the

duodenojejunal flexure where it joins

the jejunum. The duodenojejunal

flexure is surrounded by a peritoneal

fold containing muscle fibres: the

ligament of Treitz.



Ulcer

Destructive process of the

mucous membranes and

underlying layers,

common in the stomach

and duodenum, caused by

the damaging action of

chloride-peptic secretion

Definition

Other locations: distal esophagus, post-anastomotic jejunal loop, Meckel's diverticulum



Positions of Ulcers

STOMACH: on top of small

curvature, inintermediate portion between

the body and pyloric antrum

DUODENUM: commonly in the

bulb, immediate

near the pylorus



Most common causes of

Ulcers

Infection by Helicobacter

Pylori (After 1980)

Gastric acid

hypersecretion

Stress

Smoke



almost every time, an acute gastric

mucosal lesions is caused by theuse or abuse of anti-inflammatory

drugs, including aspirin, that is

acetylsalicylic acid or other

(indomethacin, ibuprofen,naproxen, tolmetin, sulindac,

piroxicam, fenoprofen).

In these cases in the patient, since

the drug is absorbed throughbackscattering in the gastric

mucosa, there are superficial antral

erosions with bleeding.



The most common sintoms

difficulty in swallowing food;

nausea and vomiting;

vomiting of blood coagulation;

loss of weight;

tiredness;

severe abdominal pain.



Gastric Ulcers

the ulcer was confirmed by endoscopic examination and

radiological

very important is the differential diagnosis with stomach cancer

the first symptom is commonly

represented by epigastric pain.

antacids provide prompt relief,

while food, after a temporary

wellness, can induce growth.



Duodenal Ulcer

The pain typically appears from

1 ½ to 3 hours after a meal

(late)

An ingestion of food results in

a resolution of pain in a short

time

A typical seasonal increase inspring and autumn



Clinical Differences

STOMACH:

-older age

- decreased motility

- reduced secretion at rest

-DUODENUM:

- more sensitive to the resting

basal stimulus

- regress with food



Complications of Ulcers

Hemorrhage

Perforation (the most

common site duodenum)

Pyloric stenosis

M alignant degeneration

(1-5% of gastric cases

caused by Helicobacter

Pylori)

Malignant ulcer: endoscopic

view of cancer



TherapyBefore talking about the diet in case of ulcer, shown the severity of the disease, is right

to say a word about medical treatments, which are much more timely and useful

ME DICAL TH ER APY

In about ¾ of patients with ulcer, medical treatment (antacids, histamine H2

receptor antagonists, proton pump inhibitors, somatostatin) is sufficient tostop the bleeding and stabilize the condition.

The placement of a nasogastric tube of large caliber allows flushing of the

stomach, the aspiration of blood clots, and monitoring any resumption of

bleeding.

The electrocoagulation, a lasercoagulation, tissue adhesives, fibrin glue,

collagen can be useful sometimes decisive.

In patients infected by Helicobacter pylori will be associated an antibiotic antibiotic therapy.therapy.



Surgical Therapy25% of patients with an acute ulcer still requires the use of

emergency surgery.

The surgery is aimed first of all to identify and arrest (by

suturing / or ligation) the source of hemorrhage.

After, it's possible to proceed to one of the surgical

treatment valid for ulcer:Vagotomy simple

Vagotomy + antrectomy (with Reset of gastrointestinal

continuity).



Diet for Ulcera

Gastric ulcer belongs to a

category of diseases for

which it described a diet

that reduces the secretion

of stomach acid and avoidexcessive mechanical

distension of the stomach

wall.

There are many herbal and homeopathic remedies for thetreatment of peptic ulcer. But if the disease is not treated, it can

give serious complications. So they should be taken under

medical supervision.



The diet in case of ulcer is a diet low in vitamins B1, C, calcium and iron. It

can be used in case of gastric and duodenal ulcer, bleeding or healing

phase). In general, the diet for an ulcer is governed by the following

points:

eat at regular intervals,

variety of foods,

exclude irritant and stimulants foods for of the secretions of thestomach.

Other suggestions:

Eat slowly, chewing carefully

Have a snack between main meals and before bedtime

Avoid heavy meals (with the ulcer is better to eat little but often)

Avoid tea, coffee, alcohol, fried foods, fatty cheeses, fatty meats, spices



Ulcers: The "Good" foods

Bread toasted, dry, crust of bread, crackers, bread sticks, rusks,

biscuits, rice, pasta, semolina, corn, cream of vegetables and

legumes, pasta with olive oil and fresh tomatoes)

drinking milk or in various foods (mashed potatoes, cakes, cream,

white sauce ...).

Unfermented fresh cheese (mascarpone, mozzarella, smoked

cheese, crescenza), boiled eggs, poached, even as an ingredient in

other preparations, but not fried.

Lean veal, chicken, rabbit, pork, lean, leg of lamb, and ham.

Fresh fish lean boiled or grilled or baked (sole, trout, perch and

hake, sea bass, sea bream) never fried.




Vegetables: vegetable soups in general, potatoes (not fried), lettuce,

artichoke hearts, cooked carrots, red beets, small peas cooked and

mashed, beans, tomatoes (skinned and seeded), finely chopped

celery.

Fruit cooked and mashed

fresh fruit ripe, peeled and seeded.

Beverage: barley coffee and only after meals, non-carbonated water,

various teas, non-acidic fruit juices diluted with water.

Sweets: sugar, fruit cakes, meringue, candy, dry biscuits, fruit jellies,

butter, olive oil, aromatic herbs, lemon juice instead of vinegar.




The main Property of the extracts of

liquorice root is its cytoprotective, anti-inflammatory and healing activity on

gastric and duodenal mucosa. All this is

due in particular to the glycyrrhizin, which

acts by direct contact with the lesion, and

with an indirect stimulus to production of

mucus by the cells of the gastric wall.Liquorice is very specified in the

prevention and treatment of gastric and

duodenal ulcers, gastritis and ulcer caused

by drugs (NSAIDs, steroids).

Liquorice




Cabbage Fights gastric

ulcer, duodenal ulcerand intestinal ulcers

Cabbage




Kohlrabi fights gastric

ulcer, duodenal ulcerand intestinal ulcers

K ohlrabi




This juice is precious

for its properties:

It is efficient for cases

of gastric and

duodenal ulcer.

Potatoes Juice



A new Discovery!

A recent study, published on the

world-magazine of

gastroenterology, discovered

the protective effects of arugula

about gastric and duodenal

ulcer in an animal model

(mouse).

Although the prickly taste, the

arugula protected the mice's

stomach from damage, inducedby alcohol and indomethacin.

The results are very good, and

certainly should be detailed on

man before take conclusions.



Ulcers: The Bad foods

Fresh bread: soft part or undercooked bread , rye bread, wholemeal flour, fat soups

or whit whole vegetables, soups with fried, soup with meat broth, seasoned pasta

too much seasoned with sauces and spices.

Condensed milk, cold milk, cheese or spicy fermented.

Fried eggs, omelet fried.

Fatty meats and meats served with sauces, preserved in salt, smoked, not cooked,

fried, stews, casseroles, roasts, fat pork, mutton, venison, goose, duck, turkey,salami, Bologna sausage, sausages.

Fatty fish: sardines, herring, anchovies, eel, salmon, cod.

All preparations fried, smoked, dried, salted



Ulcers: The Bad foods

All nuts, figs, bananas, chestnuts, oranges, tangerines, grapes, dates, walnuts,

almonds, hazelnuts, sour fruit, all just ripe fruit.

Pure wine, beer, all carbonated drinks, carbonated water, tea, concentrated

coffee, especially with empty stomach, liqueurs and alcoholic drinks, all the

frozen drinks, all liquids are too hot, acidic fruit juices (lemon, grapefruit, orange,

apricot).

fried Sweet, stuffed, made with puff pastry, with cream, cocoa, chocolate, ice

cream, sorbets.

All cooked fat, especially if cooked longer, fried foods, lard, all the spices,

mustard, vinegar.

All stored and fermented food.



Breakfast200 ml of milk or yogurt or barley coffee with one packet of sugar

2 slices toast with honey or 30 grams. bread

Lunch

60 gr. rice or pasta, or semolina or cream of rice cooked in milk with a knob of butter

140 gr. veal or grilled scallops, or 140 gr. chicken in the oven or 210gr. sole in white or 2

eggs

200 gr. zucchini (or carrots or green beans), steamed

30 gr. unsalted bread

150 gr. baked apples or pears or fresh fruit ripe

Break

2 slices with 30 gr. of jam and a cup of decaffeinated tea or coffee barley

Dinner

35 gr. rice or noodles in vegetable broth or cream of rice milk (200 ml)

60 gr. of mozzarella cheese or soft cheese or 2 eggs or 120 grams. of ricotta cheese

Mashed potatoes and carrots

2 slices bread or bread sticks

An example of 1600 calorie diet for Ulcers

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Gastroduodenal Peptic Ulcer