06-05-2021 / Digestive Disease & Gastroenterology

Stomach Ulcer Diet and what to eat

Various factors or irritants such as aspirin, alcohol, certain drugs, etc., can contact the mucosal lining and degenerate it, and cause stomach ulcers. This article will help you to understand stomach ulcers and how to manage them with a balanced diet.

Stomach Ulcer Diet and what to eat
Mazia AhmedMazia Ahmed

Mazia Ahmed

MSc Nutrition Science, Ph.D. Scholar

Table of Content

Introduction

Stomach ulcers (or peptic ulcers) are the localized erosion of the mucosal lining of those portions of the alimentary canal that comes in contact with gastric juice. The majority of ulcers are found in the duodenum (first part of the small intestine); however, they may also occur in the food pipe, stomach, or jejunum (second part of the small intestine).

How are ulcers formed?

Sometimes, the balance between stomach acid production and its resistivity created by the stomach's mucous layer gets disturbed. As a result of the excessive acid production, or weakening of the integrity of the mucosal lining (protective sheet) or both, the mucosal lining is broken, and the underlying layers of the stomach are exposed to the effect of the concentrated acid resulting in stomach ulcers. Various factors or irritants such as aspirin, alcohol, certain drugs, caffeine, bile acid, etc., can contact the mucosal lining and degenerate it. The infection of Helicobacter pylori bacteria can also form ulcers.

Stomach ulcer | Peptic Ulcer

Symptoms and Clinical Findings

  • Epigastric pain and heartburn due to reflux of acid into the food pipe one to three hours after having a meal is often the chief complaint. The pain may be described as dull, piercing, burning, or gnawing and is usually relieved by taking food or antacids.

  • Discomfort and formation of gas in the upper part of the abdomen. The basis of pain may be the action of un-neutralized stomach acid on exposed nerve fibers at the site of ulcers.

  •  Pain is also associated with gastric distension after ingesting large amounts of foods or liquids.

  • Low protein levels may be present in the blood, which delays the healing of the ulcers.

  • Weight loss and iron deficiency anemia are common.

  • The intake of iron, vitamin C, vitamin B complex may be low because of self-imposed limitations of leafy green vegetables and other good sources of these nutrients.

  • In some instances, a hemorrhage (bleeding) is the first indication of an ulcer and requires surgical intervention. Other complications such as obstruction, perforation, and carcinoma of the bleeding ulcer are also treated surgically.

  • Bleeding ulcers can result in vomiting, known as haematemesis (dark brown in color).

  • There is a sudden contraction (spasm) in the gastric region which may give rise to a feeling of sickness, distension and prevent food ingestion. 

Treatment

The treatment procedure should focus on relieving the symptoms, healing ulcers, and preventing complications like surgery. First of all, antibiotics against Helicobacter pylori should be given. Also, it is essential to neutralize the excess acid produced. For this, antacids are the earliest and most logical method for providing relief. Various other drugs that block the synthesis of acids and provide resistance to the stomach lining are also prescribed. Along with the medication, dietary guidelines should also be followed strictly.

Stomach Ulcers- Symptoms, Causes, and Treatment

Dietary Management of Stomach Ulcer

  • It is customary to suggest a bland diet for ulcer patients. A bland diet is a diet that is mechanically, chemically, and thermally non-irritating. 

  • Mechanically irritating foods include those with indigestible carbohydrates, such as whole grains and most raw fruits and vegetables. 

  • Chemically irritating foods include meat extractives, caffeine, alcohol, and spicy foods. These foods come under this category because they can stimulate gastric secretion. The capsaicin present in chilies causes shedding of surface stomach cells and may cause stomach distress.

  • Thermally irritating foods are those that are ordinarily served at extreme temperatures, such as very hot or iced liquid may cause pain. 

  • Bland diet, therefore, prevents irritation to the mucosal lining of the stomach, avoids an increase in acidity, and aids in controlling pain.

  • But the modern clinical practice of dietary management for stomach ulcers requires much more effort and planning than that.

Some of the significant points to consider while managing Stomach Ulcer with Diet

  1. Optimum total nutrition: There must be optimal overall nutritional intake to support recovery and maintain healthy tissue, based on individual needs and food tolerances.

  2. Protein-rich foods: Foods rich in protein, such as milk, may neutralize acidity, but they increase the production of gastric juice more than fats and carbohydrates. Milk should be added to the diet as a source of nutrient factors for healing purposes. Protein helps in providing the necessary amino acids for the synthesis of tissue protein which helps in healing ulcers.

  3. Fat: Moderate amounts of fat help to suppress gastric secretion. Fats such as butter, cream, and olive oil can be beneficial in thin patients. It is not advised to take fried foods as they are difficult to digest and often aggravate the symptoms.

  4. Ascorbic acid: It is assumed that low antioxidant levels predispose H. pylori infection. It is advised for such patients to increase their vitamin C intake. It helps in wound healing. Citrus fruit juice and tomato juice are found to be helpful. No food has sufficient acidity in itself to affect the stomach pH or cause direct irritation on an ulcer.

  5. Gas formers: Also, certain foods such as cabbage, cauliflower, onions, turnips, and fried foods are traditionally forbidden. Restrictions of these foods are based on subjective evidence from patients who experience distress following ingestion of these items. Large meals are also avoided.

  6. Fiber: A regular diet, including good food sources of dietary fiber, has proven beneficial.

  7. Potential irritants: Caffeine, ethanol, aspirin, and nicotine may delay healing, but there is little evidence to show that these substances induce ulcers. Chilies, pepper, ginger, garam masala, and strong tea or coffee increase hydrochloric acid secretion and aggravate the condition.

High-Fiber Foods

10 Dietary Guidelines of Stomach Ulcer

1. Whenever a patient is on a bland diet or regular diet, he needs to know which foods are needed for a nutritionally adequate diet and the importance of including these daily.

2. He/she should select from a wide variety of foods, omitting those foods known to be distressing to the patient.

3. The moderate use of seasonings is permitted.

4. Regularity of mealtimes is essential. Small and frequent meals should be taken.

5. In between meals, protein-rich meals should be taken.

6. It is suggested to take a moderate amount of food. Heavy meals are avoided.

7. Having food outside the house will not cause any harm if good judgment is used in the selection of food.

8. Food must be consumed in a relaxed atmosphere, and the person should forget about the personal and family problems while having meals.

9. A short relaxation time before and after meals may be conducive to greater enjoyment of meals.

10. Food must be well-chewed and eaten slowly. 'How' the food eaten is more important than 'what' is eaten because fast-eating provokes gastric feeding reflux.

Smoking and Alcohol

Smoking and drinking alcohol should be avoided, particularly on an empty stomach. Both of these can cause incompetence and reflux of intestinal juice into the stomach. They also interfere with the gastric acid and secretion of protein-digesting enzymes.

Good Night Rest

Good physical and mental health is fundamental if the person learns to constructively cope with his/her problems. Mental and physical rest is an important modification of living and work habits is needed when overworking and physical stress cause exacerbations of the disease. The patient should remember that anxiety and worry can upset digestion.

Foods to be Included

Dairy products like milk, cream, butter, mild cheese, and eggs (not fried), steamed fish, rice, rice flakes, puffed rice, well-cooked cereal, semolina, cooked green leafy vegetables, custards, malted drinks, and cooked pulses (if they are not causing gas formation) can be included in the diet.

Foods to be Avoided

Alcohol, strong tea, coffee, cola beverages, gravies, pickles, spices, chilies, curries, condiments, all fried foods, pastries, cakes, heavy sweets like halwa, barfi, raw unripe fruits, raw vegetables like cucumber, onions, radish, and tomatoes should be avoided.

Food to Avoid if you have Stomach Ulcer Infographics

Modification of the Diet in Bleeding Ulcers

  • In patients with bleeding ulcers, H. pylori eradication and ulcer healing are done by reducing gastric secretion.

  • The degree of dietary modifications in bleeding ulcers depends on the peculiarities of the individual case. In severe hemorrhage, it is customary to have no food at all until the bleeding has been controlled and the patient's condition is stabilized. 

  • If hemorrhage is not severe, and if nausea and vomiting are not a problem, the patient may desire food and tolerate it well. 

  • It is advised to initiate the dietary treatment by taking milk at two hours intervals with small feedings of easily digested foods such as eggs, custards, simple puddings, toast, and tender cooked fruits and vegetables. Gradual progression in amounts and types of foods is made as the patient improves.

Gastric Surgery

  • A stomach ulcer is primarily a medical disease, but surgery is advised when the ulcer is complicated by hemorrhage, perforation, or obstruction. After most types of gastric surgery, all oral intakes of foods and fluids are suspended until GI tract function returns. Once the function is regained, liquids are initiated, after which the patient can progress to solids, as tolerated by volume and consistency.

  • The first type of fluid allowed by mouth is usually water, typically administered in the form of ice, given in small amounts and allowed to melt in the mouth or as frequent sips of water. Later, larger amounts and varieties of fluids can be offered, followed by small amounts of soft, starchy, and low-fat protein foods. Highly spiced and fatty foods may not be well tolerated by the patient. Small, frequent meals or snacks are usually better tolerated than large meals.

Word of Wisdom

Primary treatment of gastric ulcer is by giving antibiotics against Helicobacter pylori bacteria. A liberal diet suitable for the patient is suggested. Nowadays, very rarely are surgeries done for gastric ulcers. Just taking care of the diet and reducing the infection is more than enough for treating ulcers. 

Reference:

National Library of Medicine 

National Institute of Health

Research Gate

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