Pectic ulcer vs

Gastritis
By Ms. Aimen Ramzi
Mphil in Food sciences and human nutrition
From UVAS
Definition
Gastritis Peptic Ulcer
Inflammation of the stomach Localized erosion (ulcer) in the
lining (mucosa) stomach or duodenal mucosa
Causes

Gastritis Peptic Ulcer

- H. pylori infection (most
- H. pylori infection (chronic
common) - NSAIDs, aspirin,
gastritis) - NSAIDs, aspirin,
corticosteroids - Zollinger-Ellison
alcohol, stress, smoking -
syndrome (excess acid
Autoimmune factors (e.g., in
production) - Stress (critically ill
pernicious anemia)
patients)
Pathophysiology

Gastritis Peptic Ulcer

Inflammatory infiltration (PMNs or Mucosal defect with tissue
mononuclear cells) without breakdown, often penetrating
mucosal break beyond the muscularis mucosae
SYMPTOMS

Gastritis Peptic Ulcer

- Dull/burning epigastric pain
(often relieved by food in
- Nausea, vomiting - Epigastric
duodenal ulcers) - Nausea,
pain - Bloating, anorexia -
vomiting - Bloating, weight loss -
Hemorrhage in severe cases
Possible GI bleeding (melena,
hematemesis)
DIAGNOSIS

Gastritis Peptic Ulcer

- Endoscopy with biopsy - H. - Endoscopy (EGD) confirms ulcer
pylori testing (blood, breath, - H. pylori testing - Imaging (if
stool) perforation suspected)
TREATMENT

Gastritis Peptic Ulcer

- Antibiotics for H. pylori - PPIs to
- Remove causative agent -
reduce acid - Avoid NSAIDs,
Antibiotics for H. pylori - PPIs or
smoking, alcohol - Surgery (rare,
H2 blockers
for complications)
COMPLICATIONS

Gastritis Peptic Ulcer

- Atrophic gastritis - Pernicious - GI bleeding - Perforation -
anemia - MALT lymphoma Gastric outlet obstruction
MEDICAL NUTRITION
THERAPY
PECTIC ULCER VS GASTRITIS
 Aspect Gastritis Peptic Ulcer

- Protect ulcerated mucosa - Reduce

- Reduce inflammation of gastric mucosa - Avoid
Goals acid secretion - Support healing and
irritants - Promote healing
prevent complications
- Similar to gastritis (bland, low-
- Eat bland, non-irritating foods - Avoid known
irritant diet) - Focus on foods that
triggers (spicy, acidic, fried foods) - Consume soft,
Dietary Approach buffer acid (milk, oatmeal) - Avoid
well-cooked foods - Avoid alcohol, caffeine, and
food that increases gastric acid
smoking
(coffee, alcohol, high-fat meals)
- Small, frequent meals - Avoid
- Small, frequent meals - Avoid large meals that
Meal Pattern fasting or going long periods without
stretch stomach wall
food (can worsen ulcer pain)
- Same as gastritis, plus: - Spicy
- NSAIDs and irritant foods - High-fat and fried foods if they aggravate symptoms -
Avoid
foods - Alcohol, smoking, caffeine Late-night eating or lying down after
meals
- Iron and B12 absorption may be
Nutrients of - Iron and B12 if chronic gastritis leads to reduced if long-term PPIs are used -
Concern deficiency (especially in atrophic gastritis) Monitor protein and calories if
weight loss occurs
- Probiotics may help reduce
- Probiotics (e.g., yogurt with live cultures) may
recurrence of H. pylori after
support mucosal healing - Antioxidant-rich foods
Functional Foods treatment - Flavonoid-rich foods
(e.g., fruits, vegetables) may help reduce
(apples, green tea, berries) may
inflammation
inhibit H. pylori
- Same as gastritis – dietary support
H. pylori - If positive: include triple therapy (antibiotics +
is adjunct to medical eradication
Consideration PPIs) alongside supportive diet
therapy
General Recommendations for Both Conditions

 Hydration: Maintain adequate fluid intake,

but avoid drinking large volumes with
meals.
 Texture: Initially, soft or pureed foods may

be better tolerated.
 Tolerance-Based: Individual food triggers

vary – food diaries can help identify

personal irritants.
 Lifestyle: Encourage stress management,

weight control, and smoking cessation.

 Introduction to H. pylori:
◦ Helicobacter pylori is a gram-negative bacterium
resistant to stomach acid.
◦ It is responsible for chronic gastritis, peptic ulcers,
gastric cancer, and atrophic gastritis.
 Changing Classification of Gastric Cancer:
◦ Gastric cancer is now categorized by location: gastric
cardia (upper part) and noncardia (rest of the
stomach).
◦ H. pylori is a strong risk factor for noncardia gastric
cancer.
 Research Findings:
◦ Finnish study: H. pylori increases noncardia cancer risk
eightfold.
◦ Surprisingly, it decreases cardia cancer risk by 60%.
 Implications for Treatment and Diagnosis:
◦ Treating H. pylori may reduce noncardia cancer risk
but potentially increase cardia or esophageal cancer
risks.
◦ Developed countries have reduced infection rates due
to better testing and treatment.
 Epidemiology and Transmission:
◦ Infection is mostly acquired in childhood, but
diagnosed in adulthood.
◦ Transmission is via contaminated food and water.
◦ Prevalence is 10% in developed vs 80–90% in
developing countries.
 Disease Progression:
◦ Many with H. pylori do not develop ulcers.
◦ Risks increase with duration of infection, strain of
bacteria, host genetics, and age at onset.
Dumping syndrome
 A complex GI and vasomotor response to large amounts of
hypertonic foods or liquids entering the proximal small
intestine rapidly.
 Commonly occurs post-surgery, particularly after:
 Total or partial gastrectomy
 Pyloric manipulation
 Fundoplication
 Vagotomy
 Gastric bypass for obesity
 Can occasionally occur in non-surgical patients.
 In normal individuals, symptoms can be reproduced by infusing
glucose into the jejunum.
 Incidence is decreasing due to:
 Better peptic ulcer management
 Use of selective vagotomies
 Improved surgical techniques
 Early Symptoms (10–30 minutes post-meal)
 Caused by rapid influx of hyperosmolar contents
into the small intestine.
 Leads to fluid shift from the bloodstream to the
intestinal lumen.
 Results in intestinal distention with symptoms like:
◦ Cramps
◦ Bloating
◦ Abdominal pain
◦ Nausea
◦ Vomiting
◦ Diarrhea
◦ Headache
◦ Flushing
 Late Symptoms (1–3 hours post-meal)
 Primarily vasomotor symptoms due to

reactive hypoglycemia:
◦ Perspiration
◦ Weakness
◦ Confusion
◦ Shakiness
◦ Hunger
◦ Hypoglycemia
Causes and medical
management
 caused by:
◦ Rapid carbohydrate absorption
◦ Exaggerated insulin release
◦ Involvement of gut peptides like:
 Glucose insulinotropic polypeptide (GIP)
 Glucagon-like peptide-1 (GLP-1)

 Medical Management
 First-line treatment: Dietary modification
◦ Effective for most patients
 Persistent severe cases (3–5%) may need medication:
◦ Acarbose – delays carbohydrate absorption
◦ Octreotide – inhibits insulin secretion
 Surgical intervention is rarely needed
BOX 27-5 Basic Guidelines for
Dumping Syndrome
 1. Eat small, frequent “meals” per day.
 2. Limit fluids to 4 ounces (1⁄2 cup) at a meal, just enough
to “wash” food down.
 3. Drink remaining fluids at least 30 to 40 minutes before
and after meals.
 4. Eat slowly and chew foods thoroughly.
 5. Avoid extreme temperatures of foods.
 6. Use seasonings and spices as tolerated (may want to
avoid pepper, hot sauce).
 7. Remain reclined at least 30 minutes after eating.
 8. Sugar-containing foods and liquids are limited. Examples:
fruit juice, Gatorade, PowerAde, Kool Aid, sweet tea,
sucrose, honey, jelly, corn syrup, cookies, pie,.
 9. Complex carbohydrates are unlimited (e.g., bread,
pasta, rice, potatoes, vegetables).
 10. Include a protein-containing food at each meal.
 11. Limit fats (less than 30% of total calories). Avoid
fried foods, gravies, fat containing sauces,
mayonnaise, fatty meats (sausage, hot dogs, ribs),
chips, biscuits, pancakes.
 12. Milk and dairy products may not be tolerated
because of lactose. Introduce these slowly in the diet
if they were tolerated preoperatively. Lactose-free milk
or soy milk is suggested
 Etiology (Causes)
 Definition: Delayed gastric emptying without
mechanical obstruction.
 Common causes:
◦ Diabetes mellitus (especially uncontrolled)
◦ Viral infections
◦ Post-surgical changes (gastric surgery)
 Other associated conditions:
◦ Idiopathic (~30% of cases)
◦ Acid-peptic disease
◦ Gastritis
◦ Gastric smooth muscle disorders
◦ Neuropathic disorders
◦ Psychogenic disorders
◦ Long-term uncontrolled diabetes
 Pathophysiology
 Gastric motility regulated by chemical and
neurologic mechanisms
 Disruption leads to delayed gastric
emptying, causing symptoms:
◦ Abdominal bloating
◦ Decreased appetite
◦ Anorexia
◦ Nausea & vomiting
◦ Fullness and early satiety
◦ Halitosis (bad breath)
◦ Postprandial hypoglycemia
 Diagnosis
 Gold standard test: Scintigraphy

(gastric emptying study)

◦ Involves a radiolabeled meal (e.g.,
⁹⁹ᵐTechnetium-labeled egg)
◦ Imaging taken over 4 hours
 Abnormal results:
◦ >50% meal retention at 2 hours
◦ >10% meal retention at 4 hours
Symptom Management

 Symptoms affect oral intake and nutritional status.

 Primary treatment goals:
◦ Control nausea and vomiting
◦ Enhance gastric motility
 Medications:
 Prokinetics:
◦ Metoclopramide
◦ Erythromycin
 Antiemetics: For symptom relief
 Other considerations:
◦ Treat small intestinal bacterial overgrowth (SIBO)
◦ Manage appetite suppression
◦ Consider ileal brake and bezoar formation
Bezoars (Undigested food masses in the
stomach)

 Caused by:
◦ Undigested plant materials (phytobezoars): e.g.,
cellulose, fruit tannins
◦ Medications (pharmacobezoars): e.g., sucralfate,
cholestyramine
 Treatments:
◦ Enzymes: papain, bromelain, cellulase
◦ Lavage or endoscopic removal
 Prevention:
◦ Avoid high-fiber, hard-to-chew foods
◦ Monitor dental health
 Severe Cases
 Gastric pacemakers: May help improve

emptying in select patients

 Enteral nutrition:

◦ Short term: Nasoenteric feeding tube

◦ Long term: PEG-J (Percutaneous Endoscopic
Gastrostomy with Jejunal extension)
MNT
 Meal volume:
◦ Large meals (≥600 ml) delay emptying → Use small, frequent meals
 Liquids vs solids:
◦ Liquids empty faster (gravity-aided) → Emphasize pureed/liquid
foods
 Hyperglycemia:
◦ Delays gastric motility acutely and damages nerves long-term
◦ Monitor A1C and glucose control in diabetics
 Fiber:
◦ Avoid high-fiber foods and supplements
◦ Watch for particle size (e.g., potato skins, nuts)
 Fat:
◦ Inhibits emptying via cholecystokinin (CCK)
◦ Fat in liquid form often tolerated
 Osmolality:
◦ Concentrated foods may slow emptying
 Additional Considerations:
 Avoid medications that delay motility:

narcotics, anticholinergics
 Nutritional labs to monitor:

◦ A1C (for diabetes)

◦ Ferritin, Vitamin B12, 25-OH Vitamin D
 Check dentition: Missing teeth or poor
chewing ↑ bezoar risk