Abstract
This chapter will discuss a peptic ulcer disease (PUD) case. PUD is a common gastrointestinal tract disease (GIT) that affects the stomach and duodenum. It is characterized by deep lesions into the mucosal thickness. Various dietary and behavioral choices could aggravate the epigastric pain associated with PUD and interfere with the healing process leading to complications. Management of PUD includes medical treatment with medications along with behavioral and nutritional changes. This case presents a complication of PUD, and choices exacerbating the condition. It will also discuss the role of medical nutrition therapy in minimizing the symptoms and promoting ulcer healing. Additionally, it will allow the dietetic professional to methodically assess the elements in the case that are relevant for planning the nutrition intervention; in addition to, educating the patient about dietary modifications to improve the patient's quality of life.
TopPathophysiology
To understand the pathogenesis of PUD, it is essential to explain the defense mechanism of the gastroduodenal mucosa and gastric secretion process. First, it is crucial to acknowledge that the innermost layer surrounding the lumen of the gastrointestinal (GI) tract, which is the GI mucosa, is always under attack by aggressive factors. These hostile factors can be either endogenous factors, such as hydrochloric acid (HCL), pepsin, and bile salts, or exogenous factors including medications, ethanol, and bacteria. Fortunately, the mucosal barrier is protected from those agents by a three-level defense mechanism: preepithelial, epithelial, and subepithelial (Jameson et al., 2018; Li et al., 2014). These levels maintain the mucosal integrity through: (a) the production of prostaglandins (PGs); (b) the secretion of mucus and bicarbonate (HCO3﹣); (c) removal of excess acid by uninterrupted blood flow; (c) and the rapid regeneration of epithelial cells. The PGs are vital for the regulation of the release of HCO3﹣ and mucus, inhibition of the HCL acid secretion from parietal cells, and maintenance of mucosal blood flow (Jameson et al., 2018).
Key Terms in this Chapter
Epigastric Pain: The discomfort or pain that is felt in the upper area of the abdomen, which could be because of acid reflux, gastritis, a peptic ulcer, or others.
Proton-Pump Inhibitors: A group of ulcer-healing drugs used for inhibiting stomach acids through blocking the H+/K+ ATPase enzyme that is involved in the HCL production and which are the most potent acid inhibitory agents (omeprazole, esomeprazole, lansoprazole, rabeprazole, and pantoprazole).
Gastritis: A term that describes inflammation of the stomach.
Dyspepsia: Indigestion, which refers to a group of nonspecific symptoms, including upper abdominal pain or discomfort, fullness, gas, bloating, belching, or nausea.
Migraines: A condition characterized by a throbbing or painful sensation often at one side of the head that might be accompanied by nausea, vomiting, and sensitivity to light and sound.
H2 Antagonist Receptors: A group of ulcer healing drugs used for inhibiting stomach acid by blocking the release of histamines, which are involved in the production of HCL (cimetidine, ranitidine, famotidine, and nizatidine).
Prostaglandins: A group of fatty acids derived from esterified arachidonic acids that are critical for gastric defense due to regulating mucus and HCO 3 release, inhibiting parietal cell secretion of HCL, and maintaining mucosal blood flow.
Melena: The condition of passing black tarry stools, which are associated with upper gastrointestinal bleeding.
Antacids: A group of medications used to provide relief by neutralizing the acidic environment in the stomach.
Parietal Cell: A gastric gland cell at the basement membrane that is responsible for the secretion of HCL and intrinsic factor.
Helicobacter Pylori: Gram-negative bacteria that are resistant to stomach acid and could result in various conditions, including gastritis, PUD, and gastric carcinoma.
Nonsteroidal Anti-Inflammatory Drugs: A category of medications indicated for the reduction of inflammation, fever, pain, and prevention of blood clots (Aspirin, ibuprofen, naproxen, diclofenac, celecoxib, and others).
Acetylcholine: A neurotransmitter that is released from the vagus nerve and other cholinergic nerves and acts in the GI by stimulating its activity.
Intrinsic Factor: A glycoprotein that is secreted by the parietal cells to bind to vitamin B12 to facilitate its absorption in the terminal ileum.
Hematemesis: The condition of vomiting blood that is associated with upper gastrointestinal bleeding.
Serologic Enzyme-Linked Immunosorbent Assay: A test that measures antibodies in the blood that are specific to H.pylori , but which does not differentiate between an active or past infection.
Esophagogastroduodenoscopy: A procedure involving the passage of a long flexible tube with a light that examines the esophagus, stomach, and upper small intestine.
Chyme: The mixture of food and gastric secretion that passes down from the stomach.