1. Peptic Ulcer
Disease
By: Hillary Sullivan
Ohio University
NUTR 4100: Medical Nutrition Therapy II
November 26, 2013

2. 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

3. Types of ulcers
 3 categories
 Esophageal
 Gastric
 Duodenal

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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.

12. 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

13. 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

14. 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

15. Intervention Goals
 Optimize nutritional intake to meet nutrient needs
 Implement dietary and lifestyle factors that will
reduce symptoms, decrease pain, and promote
healing

16. 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

17. 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