Peptic ulcer
A peptic ulcer is an open sore in the stomach or duodenum where acid and pepsin act. Most are caused by H. pylori or painkillers (NSAIDs).
At a glance
Gastric vs duodenal ulcer
Dietary principles
| Point | Recommendation | Why |
|---|---|---|
| Meal pattern | Small, frequent meals (3 meals and 2-3 snacks); eat slowly; no food 2 hours before sleep | Avoids an empty stomach and large meals; a bedtime snack raises night-time acid |
| Energy and protein | Adequate energy; normal protein (about 1 g/kg) | Protein heals tissue; very high protein and large milk feeds raise acid |
| Fat | Moderate; avoid deep-fried foods | Fried and fatty foods slow stomach emptying and cause discomfort |
| Fibre | Normal; soluble fibre (oats, banana, cooked vegetables) is well tolerated | No need for a strict low-fibre diet |
| Irritants | Avoid alcohol, smoking, coffee (even decaffeinated), strong tea, colas, black pepper, chilli powder, meat extracts | These raise acid or irritate the lining |
| Vitamins and minerals | Vitamin C foods as tolerated; iron-rich foods if there was bleeding | Help healing and correct anaemia |
Foods to include and avoid, and a sample menu
| Item | Details |
|---|---|
| Include | Idli, soft rice, curd rice, soft chapati, oats, moong dal, steamed vegetables, banana, papaya, curd, buttermilk, eggs, steamed fish |
| Avoid or limit | Chilli, pepper, garam masala, pickles, fried snacks, coffee, strong tea, colas, alcohol, meat soups, very hot foods, citrus juices if they cause pain |
| Early morning | Diluted milk or a glass of water with 2 marie biscuits |
| Breakfast | Idli (3) with moong dal sambar (mild, no chilli powder) |
| Mid-morning | Ripe banana |
| Lunch | Soft rice, dal, bottle gourd kootu, curd |
| Evening | Oats porridge or vegetable poha (mild) |
| Dinner (2-3 hours before bed) | Soft chapati (2), steamed fish or paneer curry (mild), carrot-beans poriyal, buttermilk |
Patients on H. pylori treatment need regular meals so the tablets are taken correctly. Teach them that no special bland food heals the ulcer; regular meals, no smoking or alcohol, and avoiding foods that hurt them is enough.
2 marks: “What is a peptic ulcer?” An open sore in the lining of the stomach or duodenum where acid and pepsin act; most are caused by H. pylori or NSAIDs.
5 marks: “Differentiate gastric and duodenal ulcers.” Site, timing of pain (soon after food vs 2-3 hours later and at night), effect of food, weight change, frequency.
10 marks: “Discuss the causes, symptoms and dietary management of peptic ulcer with a sample menu.” Define, causes, gastric vs duodenal, symptoms and complications, old (Sippy) vs modern diet, principles table, foods, menu.
Ulcer diet = little and often, no smoke, no drink, no coffee. Pain after food: gastric; pain relieved by food: duodenal.