THE NUTRITIONAL MANAGEMENT OF PEOPLE LIVING WITH PEPTIC ULCER

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THE NUTRITIONAL MANAGEMENT OF PEOPLE LIVING WITH PEPTIC ULCER

ABSTARCT

Peptic ulcer is a lesion of the mucosal lining of the upper gastrointestinal tract characterized by an imbalance between aggressive and protective factors of the mucosa, having H. pylori as the main etiologic factor. Dietotherapy is important in the prevention and treatment of this disease. The use of diet as an important part of the therapeutic regimen for the patient with peptic ulcer is a deep-rooted practice. In the first century A. D. Celsus prescribed a smooth diet, free of acrid foods at a time when little was known about disease of the stomach, and, as early as the seventh century, A. D., practitioners believed in the healing properties of milk when taken by patients whose digestive symptoms as then described suggested the likely possibility of peptic ulcer.

Peptic ulcer is a lesion of the mucosal lining of the upper gastrointestinal tract characterized by an imbalance between aggressive and protective factors of the mucosa, having H. pylori as the main etiologic factor. Dietotherapy is important in the prevention and treatment of this disease. The study employs survey design with the use of questionnaires instrument to collect data from people in Alimosho local government area of Lagos state. From the work, it is observed that adjusted to the patient’s needs aiming to normalize the nutritional status and promote healing is necessary. Recommended nutrients can be different in the acute phase and in the recovery phase, and there is a greater need of protein and some micronutrients, such as vitamin A, zinc, selenium, and vitamin C in the recovery phase. In addition, some studies have shown that vitamin C has a beneficial effect in eradication of H. pylori. Fibers and probiotics also play a important role in the treatment of peptic ulcer, because they reduce the side effects of antibiotics and help reduce treatment time.

CHAPTER ONE

1.0 INTRODUCTION

1.1 BACKGROUND OF THE STUDY

Peptic ulcer is a disease of chronic development, characterized by an imbalance between the factors that damages the mucosa and those for its protection, resulting in a lesion of the lining of the upper digestive tract. It has been one of the most prevalent diseases in the world, and some of its complications have been the major causes of morbidity and mortalitySung JJ.etal (2012;105:84-89). The prevalence differs in the world population between the duodenal and gastric ulcers, and the mean age of people with the disease is between 30 and 60 years, but it can happen in any age. According to Martins LC, Corvelo TCO, Oti HT (2002;35:307-310), racial difference has also been observed, and in Africa duodenal ulcers are found to be rare in black people, but in the United States the incidence is the same for blacks and whites; regarding gender, there is predominance of ulcers in males^.

Peptic ulcer has a multifactor etiology. Environmental elements such as alcohol and nicotine can inhibit or reduce secretion of mucus and bicarbonate, increasing acid secretion. Genetic factors can influence, and children of parents with duodenal ulcer are three times more likely to have ulcer than the population. Lafortuna CL, Agosti F, Marinone PG, Marazzi N, Sartorio A (2004;27:854-6). In the past decades, the identification of Helicobacter pylori and ulcers associated with the chronic use of anti-inflammatory drugs contributed to a better understanding of the events associated to the genesis of peptic ulcersToneto M, Oliveira F, Lopes MH (2011;21:23-30).

Nutrition and its recommendations define aspects of a healthy diet, and the need to establish nutritional benchmarks is long recognized as a way to promote health and prevent and treat diseases. Accordingly Reis NT. Nutrição clínica: sistema digestório (2003), dietotherapy has played a key role in the prevention and treatment of Peptic ulcer, with the main purpose of recovering and protecting the gastrointestinal lining, improving digestion, relieving pain, and contributing to a satisfactory nutritional status^.Peptic ulcer is a disease known since antiquity, but there are few studies innovating dietotherapy as treatment for this disease. For this reason, the objective of this study was to review nutritional therapy of peptic ulcers in adults.

1.2 STATEMENT OF THE PROBLEM

Although most peptic ulcers heal completely with treatment, they can sometimes lead to complications. The risk of serious complications depends on the cause of the ulcer, the size and location of the ulcer, and the person’s age and health.

Bleeding — Bleeding ulcers most often affect older people. Symptoms may include blood in the vomit or in the stool (this can give stools a black, tar-like appearance). People with bleeding ulcers usually need to take a proton pump inhibitor. Some people also need IV fluids and blood transfusions in the hospital.

Ulcers that are actively bleeding, or are at risk of bleeding again, can be treated during an upper endoscopy. Treatment may involve cauterizing the ulcer, applying tiny clips to close off the blood vessels, or injecting a medication called epinephrine. The goal is to stop the bleeding and prevent future bleeding.

In rare cases, a person with a bleeding ulcer may need surgery or embolization. This involves identifying the specific blood vessels that are the source of the bleeding, and blocking off the flow of blood through them.

Perforation — Perforation is when an ulcer leads to a hole or puncture in the wall of the stomach or duodenum. Symptoms include sudden, severe abdominal pain, a rapid heartbeat, and a low body temperature. Pain may radiate to one or both shoulders, and the abdomen may become rigid.

It is important to treat a perforated ulcer as quickly as possible. Treatment usually involves insertion of a nasogastric tube (a tube that goes through the nose into the stomach), IV fluids, and medications; some people also require surgery.

Obstruction — Gastric outlet obstruction is a less common complication of peptic ulcers. It refers to an obstruction or blockage of the outlet of the stomach (the part that leads to the small intestine). Vomiting is the most common symptom; other symptoms include feeling full quickly after eating, bloating, abdominal pain, loss of appetite, and nausea.

Gastric outlet obstruction is treated by inserting a nasogastric tube to remove food and fluid that has been unable to pass from the stomach into the small intestine. Many people also need IV fluids to stay hydrated. If the obstruction is related to an ulcer that was caused by H. pylori or NSAID use, addressing those causes (treating the H. pylori infection and/or stopping NSAIDs, along with treating the ulcer with acid-suppressing medication) often resolves the obstruction.

For people who don’t respond to medication, obstruction can be treated during an endoscopy. This is done by inserting a tiny balloon to dilate (open) the gastric outlet. A biopsy may be performed to rule out other, more serious causes of obstruction, such as stomach cancer. If balloon dilation is not possible (or doesn’t work), surgery may be an option.

FOLLOW-UP

Whether or not you need follow-up monitoring for your ulcer depends on:

●The size, location, and cause of the ulcer

●How the ulcer has responded to treatment

●Whether there were any complications

Duodenal ulcers — If you have been treated for a duodenal ulcer without complications, you most likely will not need any follow-up monitoring of the ulcer itself. If the ulcer was large or led to other problems (such as bleeding or perforation), or if your symptoms persist or recur, your healthcare provider may recommend a repeat endoscopy to make sure the ulcer is healing.

Gastric ulcers — Some healthcare providers recommend a follow-up endoscopy for anyone with a gastric ulcer, to confirm that the ulcer has healed and does not contain any cancerous cells. If you had a biopsy when your gastric ulcer was initially diagnosed, and the ulcer has responded well to treatment, you may not need follow-up. Your healthcare provider will decide whether a repeat endoscopy is necessary based on your individual situation.

All ulcers caused by H. pylori — If your ulcer was due to H. pylori, your healthcare provider will probably do a test to confirm that the infection is gone. However, the blood test cannot be used to determine successful clearance of the infection. Instead, a stool or breath test is usually performed about four weeks after the initial course of treatment is completed. This is because some medications (including antibiotics and proton pump inhibitors) can cause a “false negative” test result even if H. pylori is still present.

1.3 OBJECTIVE OF THE STUDY

1. To update nutritional therapy among people living with peptic ulcer.

2. To examine prevalence of peptic ulcer disease among people in Alimosho local government area.

3. To identify the nutritional care of people in with peptic ulcer in Alimosho local government area.

4. To evaluate the healthy eating guidelines for people with peptic ulcers.

1.4 RESEARCH QUESTION

1. Can this research work help to nutritional therapy among people living with peptic ulcer?

2. Does peptic ulcer disease prevail among people in Alimosho local government area?

3. A there nutritional care of people in with peptic ulcer in Alimosho local government area?

4. Is there healthy eating guidelines for people with peptic ulcers?

1.5 RESEARCH HYPOTHESES

H0: This research work cannot help to nutritional therapy among people living with peptic ulcer.

H1: This research work help to nutritional therapy among people living with peptic ulcer.

H0: There are no nutritional care of people in with peptic ulcer in Alimosho local government area.

H1: There are nutritional care of people in with peptic ulcer in Alimosho local government area.

1.6 SCOPE OF THE STUDY

The study was carried out in the nutritional management of people living with peptic ulcer Alimosho local government area, Lagos state a case study.

1.7 LIMITATIONS OF THE STUDY

The only limitation faced by the researcher in the course of carrying out this study was the delay in getting data from the various respondents. Most respondents were reluctant in filling questionnaires administered to them due to their busy schedules and nature of their studies. The researcher found it difficult to collect responses from the various respondents, and this almost hampered the success of this study.

1.8 DEFINITION OF TERMS

Peptic ulcer disease (PUD): Peptic Ulcer was defined as a mucosal break at least 3 mm in diameter, with or without a necrotic base in the middle of the lesion, in either the stomach (gastric) or the duodenum (duodenal). In the case of several ulcers/erosions, at least one had to fulfill this definition.In this study PUD is identified by the presence of signs and symptoms through history taking or examinations or from medical records or investigation reports.

Symptom groups: ―Gastroesophageal reflux symptoms‖ were defined as troublesome heartburn and/or acid regurgitation over the past 3 months.

―Dyspepsia was defined as troublesome pain or discomfort in the epigastric part of the abdomen, or reporting of one or more of the symptoms ―uncomfortable feeling of fullness, ―early satiety, or ―nausea, ―Abdominal pain‖ was defined as troublesome pain or discomfort in the abdomen.

―Irritable bowel syndrome was defined as abdominal pain or discomfort at any site, combined with reported disturbances in bowel habits.

―Atypical PUD symptoms were defined as other gastrointestinal symptoms, except dyspepsia or ―epigastric pain or discomfort‖ concomitant with PUD.

―No symptoms or minor symptoms were defined as individual symptoms not fulfilling any of the above symptom classifications, or an absence of symptoms.

The above definitions allowed concomitant reporting of symptoms of gastroesophageal reflux, dyspepsia, and irritable bowel syndrome.

Religion: Religion refers to the denomination or belief of the family. The major religious groups in the context of the study are Muslims, Hindus, Buddhist, Christians, atheists and other beliefs.

Education: Education refers to the form of learning the parents received. Education is clustered into the types of education received into informal, formal secular and formal religious. Education is also classified according to the level of education obtained, into Illiterate (no formal school), Primary school (up to 6th grade) Secondary school (up to 10th grade) Higher secondary ( Up to college) Some undergraduate education Undergraduate education and Post graduate level.

Occupation: Occupation refers to the kind of work the parents are involved in. They are categorized into farmers/agriculture, hard labor, idle, clerical/technical and professional/administrative.

Monthly family income: Monthly income is operationalized as the total sum of family income each month in Takas and is categorized into the following: Less than 2500

 Less than 10000

 10001 to 20000

 20001 to 30000

 30001 to 40000

 40001 to 50000

 Above 50000

Residence: Residence refers to the establishment which is being used by the family as a place of dwelling or home. Residence is grouped into slums, rural mud housing (kuccha), rural brick housing (pucca), urban unplanned or cramped housing and urban – planned housing or residential areas.

Diabetes mellitus: Diabetes mellitusis a group of metabolic diseases in which a person has high blood sugar, either because the pancreas does not produce enough insulin, or because cells do not respond to the insulin that is produced. Previous medical records or history are used to assess the presence of diabetes.

Hypertension (HTN): HTN is a chronic medical condition in which the blood pressure in the arteries is elevated. HTN is assessed by the mother’s previous medical records or history.

Pain Killers: An analgesic, or painkiller, is any member of the group of drugs used to achieve analgesia — relief from pain. They include paracetamol (acetaminophen), the non-steroidal anti-inflammatory drugs (NSAIDs) such as the salicylates, and opioid drugs such as morphine and opium.

Aspirin : Also known as acetylsalicylic acid, is a salicylate drug, often used as an analgesic to relieve minor aches and pains, as an antipyretic to reduce fever, and as an anti-inflammatory medication.

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