Peptic ulcer is a serious pathology of the stomach and duodenum. Less frequently, it can affect the esophagus and upper small intestine (2% of cases).
From the etiological point of view, peptic ulcer develops following the exposure of the mucosa to gastric juices (hydrochloric acid and pepsin) m not adequately hindered by the protective mucus.
In practice, the appearance of the ulcer is caused by the imbalance between aggressive and protective factors, which act on the gastro-duodenal mucosa.
In the West, about one in ten people has suffered, suffers or will suffer from a stomach or duodenum ulcer. Men (especially middle-aged men) are affected three times more than women, particularly in the duodenum (except for Japan); sometimes, the ulcer occurs both at the gastric and duodenal level. It is possible that estrogen hormones play a protective role in fertile women.
The onset of the ulcer has a very broad behavioral basis; there is also a genetic predisposition (blood group 0). In recent years the incidence seems to have fallen significantly.
What to do
- The most important trick is undoubtedly prevention (see under Prevention). The severe ulcer, even if cured, can definitively compromise the integrity of the mucosa (scar).
- Symptom recognition: it is essential to promptly identify the symptoms of ulcer disease, to reduce the aggravation of erosion. These symptoms are:
- Epigastric pain and burning:
- In gastric ulcer, it occurs half an hour after a meal.
- In the duodenal ulcer it occurs an hour and a half and up to three hours after the meal. It can be located to the right of the abdominal line.
- Sometimes nausea and vomiting.
- Signs and symptoms of the acute abdomen (very strong pain, such as a stab, abdomen of hard consistency, wood, tablet, nausea, vomiting, sweating, tachycardia, weak pulse and taking the crouched position on one side): in this case, often the ulcer is piercing.
- In the long term, weight loss caused by anorexia and aversion to food due to the severity of the symptoms.
- In the long term, iron deficiency anemia caused by modest bleeding.
- Contact your primary care physician or a gastroenterologist for a specific diagnosis immediately. This is aimed at excluding other conditions:
- Hiatal hernia.
- Gastritis.
- Duodenitis.
- Duodenal ulcer.
- Gallbladder calculations.
- Chronic inflammation of the gallbladder.
- Stomach cancer.
- The general practitioner or specialist will carry out endoscopic and / or radiological investigations:
- Gastro esophagus duodenoscopy.
- Biopsy for the research of the bacterium Helicobacter pylori.
- X-ray.
- In case of positive diagnosis, specific therapy begins:
- Adopt a proper diet (see What to Eat and NOT to Eat below), promoting digestion, limiting gastric distension and reducing gastric secretion.
- Exclude all harmful factors (see What NOT To do below).
- Pharmacological therapy: it can be of various types (see below Pharmacological treatments).
- Surgery: only in the most severe cases or in the evolution in cancer.
What NOT to do
- Conduct an incorrect lifestyle, without complying with the prevention criteria.
- Ignore the initial symptoms.
- Do not seek medical attention for a certain diagnosis and to exclude other diseases or complications.
- Neglecting specific therapy:
- Do not follow drug therapy.
- Do not undergo surgery if deemed essential by the doctor.
- Follow an unsuitable diet.
- To smoke.
- Abuse with alcohol.
- Expose yourself to environmental contaminants potentially harmful to your stomach.
- Follow a stressful lifestyle.
- Use harmful gastro drugs, especially on an empty stomach and without the use of gastro protectors.
What to eat
The diet must be specially structured to prevent the ulcer from getting worse. The fundamental principles are three:
- Do not stretch the stomach and / or duodenum excessively.
- Limit the production of gastric juices.
- Ensure efficient and effective digestion, avoiding long stays in the stomach.
For this purpose we recommend:
- Eat small meals, such as fractioning calories as follows:
- 15% energy breakfast.
- Two snacks (snacks) at 10% or four at 5%.
- 35% lunch.
- 30% dinner.
- Choose moderate portions.
- Eat meals away from the hours of sleep.
- Use little seasoning and mainly raw-pressed vegetable oils. We recommend 4 teaspoons a day. Excess fat can compromise the digestibility and integrity of the mucous barrier.
- Prefer lean and digestible foods:
- Of animal origin (few fats and connective tissue): chicken, turkey, rabbit, defatted pork or beef, cod, anchovies, sea bream, sea bass, corvina, croaker, tuna fillet, prawns, lean ricotta, light spreadable cheese, flakes of milk, egg whites or at most one whole etc.
- Of vegetable origin (not too many fibers): cereals, legumes and derivatives, choosing those with medium or low fiber content. Fruits and vegetables in portions of 50-150g (also with peel).
- Use cooking systems that optimize digestibility:
- Boiling in water.
- Vacuum packed.
- Vasocottura.
- Steam powered.
- In a pressure cooker.
- In a hot flame pan.
- Baked (avoiding prolonged cooking and / or excessive temperatures)
- Baked.
- Fresh foods, not preserved, to be consumed "natural"; the only recommended long-term preservation method is freezing.
- Foods foods at medium temperature, not too cold or too hot.
NB : There are various forms of malnutrition related to ulcer, drug therapy and related complications. Some are: iron deficiency anemia, pernicious anemia, reduced calcium absorption and impaired general absorption.
What NOT to Eat
- Alcoholic beverages (especially on an empty stomach).
- Cocoa, black chocolate and mint.
- Stinging foods such as chilli, pepper, horseradish, ginger, large amounts of raw onion and garlic etc.
- Foods and beverages containing xanthines (especially on an empty stomach): coffee, black tea, hot chocolate, energy drinks, etc.
- Abundant meals and portions, especially before sleep.
- Very seasoned foods.
- Fatty foods, or foods rich in connective tissue or containing too many fibers: offal, fatty cuts of pork, pork rind, ossobuco, sausages, cured meats, sausages, hamburgers, salmon, eel, tuna belly, octopus, cuttlefish, mussels, clams, snails, gorgonzola, pecorino, mascarpone, fontina, brie, more than one egg yolk at a time, carpaccio, tartare, sushi, stew, ragù and the like, soups, braised meat, boiled meat, bran, uncooked legumes, portions of exaggerated vegetables etc.
- Cooking techniques that make food less digestible:
- Stewing.
- Frying in a pan.
- Long cooking in the oven or on the grill or in boiling water.
- Brazing.
- Savoury foods.
- Preserved foods:
- Sottolio.
- In brine.
- Under salt.
- Smoked and dried.
- Tendentially acid foods and drinks in significant portions:
- Vinegar.
- Beverages (for example cola).
- Citrus fruits and juice.
- Tomato and juice.
- Hot or iced foods.
- Milk.
- Broth.
- Carbonated drinks (orange, cola, etc.).
- Snacks and other junk foods.
Natural Cures and Remedies
- Sodium bicarbonate (NaHCO 3 ): in aqueous solution, it intervenes quickly, but causes some side effects such as: alkalinization of the urine, swelling, hypersodemia and sometimes diarrhea.
- Herbalist: some plants are able to improve peptic ulcer symptoms or to act positively on the mechanism of action. The best known are:
- St. John's Wort.
- Licorice.
- Passiflora.
- Chamomile.
- Comfrey.
- Calendula.
- Alginates and mucilaginous drugs that cover the gastric mucosa protecting it from aggressive agents:
- Melissa.
- Altea.
- Mauve.
- Icelandic lichen.
- Calendula.
- Mother tinctures with healing effect:
- salicaria
- Strawberry.
- Garlic: facilitates the eradication of Helicobacter pylori, but stimulates gastric secretion and is contraindicated for ulcers.
- Clove essential oil.
Pharmacological care
- Histamine H2 receptor antagonists: ranitidine, cimetidine (eg Ulis, Biomag, Tagamet), famotidine and nizatidine (eg Nizax, Cronizat, Zanizal). For oral and rarely parenteral use, they inactivate the proton pump and reduce the release of hydrogen ions.
- Antacids (such as aluminum hydroxide with magnesium hydroxide, eg Maalox plus).
- Proton pump inhibitors: block the production of histamine, gastrin and acetylcholine; in association with antibiotics they favor the elimination of Helicobacter pylori. For example:
- Pantoprazole (such as Peptazol, Pantorc, Nolpaza, Gastroloc).
- Omeprazole (such as Antra, Nansem, Losec, Xantrazol).
- Lansoprazole (like Pergastid, Lomevel, Lansox).
- Protectors of the gastric mucosa:
- Sucralfate (eg Degastril, Citogel).
- Bismuth compounds (eg salicylate bismuth).
- Analogues of prostaglandins: they protect the mucosa thanks to the reduction of gastric secretion; for example Misoprostol (as Cytotec).
- Antibiotics against Helicobacter pylori:
- Amoxicillin: eg Augmentin, Klavux.
- Metronidazole: for example Metronid, Deflamon.
- Clarithromycin.
Prevention
- Not smoking.
- Do not abuse alcohol, especially on an empty stomach.
- Follow a correct diet.
- Avoid predisposing foods.
- Limit the use of certain drugs (anti-inflammatory drugs, NSAIDs, cortisone drugs, antibiotics, etc.) or at least take them on a full stomach.
- Minimize nervous stress levels.
- If possible, do not expose yourself to environmental and chemical contaminants (vapors, fumes, etc.).
- Avoid the possibility of contagion of Helicobacter pylori, although recent studies suggest that this bacterium is present in everyone's mucosa but only become pathogenic for a few.
- Contact your doctor with the first symptoms. In this way it is possible to block the ulcer in the initial phases, reducing the severity (when it is still a simple erosion of the superficial mucosa), the therapy and the possibility of complications.
Medical Treatments
- Surgery: it is adopted when ulcers are resistant to pharmacological and behavioral therapy, when there is a suspicion of a tumor and in the case of serious complications. Consists of:
- Excision of the gastric branches of the vagus nerve, with the aim of reducing gastric secretion.
- Gastrectomy: resection of a part of the stomach.
