Peptic ulcer is characterized by open sore/sores in the lower esophagus, stomach, or duodenum. It may be single or multiple, acute or chronic, and superficial or deep. Elevated gastric acid secretion or reduced degree of protection make it susceptible to the development of peptic ulcers.

There are two types of ulcers

• Duodenal ulcer
  Most duodenal ulcers occur within the first few centimeters of the duodenal bulb.

• Gastric ulcers
  Ulcers in stomach- gastric ulcers. They are less common than duodenal ulcers. Generally develop in the lower part of the stomach, adjacent to the acid-secreting mucosa of the body.

SYMPTOMS
Duodenal ulcers- characteristic manifestation chronic intermittent pain in the upper central region of the abdomen (epigastric area). The pain begins 30 minutes to 2 hours after eating, when the stomach is empty

Gastric ulcers- cause more anorexia, vomiting, and weight loss. Gastric ulcers tend to be chronic. Incidence of hemorrhage and overall mortality is higher with gastric ulcer than duodenal ulcer.

CAUSES
The following are the most common causes for peptic ulcer.

1. Helicobacter Pylori / H.Pylori infection
2. Habitual use of aspirin and Non-steroidal anti-inflammatory drugs (NSAIDs).
3. Excessive use of alcohol
4. Smoking
5. Age greater than 65 years

Nutritional management
The main objective of nutritional management is to restore nutritional status and to correct the deficiencies with dietary modifications, reduce the symptoms, neutralize the acids and reduce acid secretion.

GUIDELINES

• Adequate energy intake should be provided to prevent subsequent weight loss. Consumption of both simple and complex carbohydrates must be encouraged.
• Adequate energy intake should be provided to prevent subsequent weight loss. Consumption of both simple and complex carbohydrates must be encouraged.
• Avoid fried foods in any form. Include healthy fat through fish, nuts, seeds, healthy plant oils as it helps to protect the mucosa lining of the stomach and intestines. Healthy fat can also delay gastric emptying.
• Fibers act as a buffer and reduce the concentrations of bile acids in the stomach and the intestinal transit time, thereby resulting in less abdominal bloating and pain. Therefore, it’s important to include a good amount of fiber through whole grains, fruits and vegetables.
• Vitamin and mineral requirements such as iron, calcium, zinc, selenium,vitamin C and vitamin A increase during ulcers. Therefore, foods such as nuts and seeds, cruciferous vegetables, eggs, fish, beans, leafy vegetables and fruits should be included in plenty. Folic acid supplementation may be required in some cases as there could be less absorption.
• Spices like chillies, pepper and coffee and other caffeine-containing beverages, Cigarette smoking and alcoholic intake should be restricted.
• Acid foods, such as vinegar, lemon, orange and other citrus fruits and their juices have been traditionally avoided by patients with peptic ulcer on the grounds that these items exacerbate symptoms. Based on how the body accepts, one can include it in small amounts.
• Small meals may be better tolerated than large ones. It’s better to avoid late dinners and complete it at least 2 hours before bedtime. Avoid bedtime snacks that stimulate acid production at night.

Peptic ulcers should be treated on time. A severe untreated ulcer can sometimes burn through the wall of the stomach, allowing digestive juices and food to leak into the abdominal cavity which may further lead to a medical emergency.

So, if you suffer from peptic ulcers, it’s important to address it by working with a Doctor and a Dietitian to build an appropriate treatment and recovery plan.