Peptic Ulcer

Peptic ulcer disease is a common disorder that affects millions of individuals each year, with a major impact on health care cost. Peptic ulcer is an erosion in the mucosa and can occur in any area that is exposed to gastric acid and pepsin, including the lower esophagus, stomach and duodenum. This erosion leaves the underlying layers of cells unprotected and exposed to gastric juices. If a peptic ulcer is located in the stomach it is called a gastric ulcer.
Normal gastric and duodenal mucosa is protected from the digestive actions of acid and pepsin by the secretion of mucus, the production of bicarbonate, the removal of excess acid by normal blood flow, and the rapid renewal and repair of epithelial cell injury. When protective factors are impaired or dimished, acid and pepsin can damage the mucosal lining.

Causes and risk factors
1. The most common cause of peptic ulcers is a bacterium called Helicobacter pylori. Even though most people have this organism living in their gastrointestinal tract, not all of them get peptic ulcer.
2. Use of aspirin and NSAIDs like ibuprofen, or naproxen.
3. Drinking alcohol excessively
4. Severe physiological stress
5. Smoking and using tobacco
1. Abdominal pain is a common symptom
2. Nause and vomiting, fatigue
3. Weight loss
4. Vomiting blood, and bloody or dark tarry stools
Treatment often involves a combination of medications
to kill the H.pylori bacteria, reduce acid levels, and protect the GI tract. This combination strategy allows ulcer to heal and reduces the chance of reoccurance. The medications may include one or more the following :
1. Antibiotic to destroy H.pylori
2. Acid blockers (like cimetidine, ranitidine)
3. Proton pump inhibitors, to reduce acid levels and allow the ulcer to heal (such as omeprazole)
4. Medications that protect the tissue lining (such as sucralfate).
1. Bleeding internally
2. Perforation of the intestine and peritonitis
3. Bowel obstruction
General dietary recommedations
1. Consuming a well balanced diet
2. There is a little rationale for completely eliminating a particular food from the diet unless it causes repeated discomfort, for example : a). Caffeine, it is containing beverages like cola, tea, and coffe that may increase acid secretion and discomfort and may be limited. b). Foods and seasonings that stimulate gastric acid secretions, such as a black pepper, garlic, and chili powder.
3. Frequent small meals may increase comfort, decrease the chance for acid reflux, and stimulate gastric blood flow but also may increase net acid output.
4. Avoid alcohol, cigarette smoking, salicylates (aspirin). and NSAIDs
5. Anemia as a result of peptic ulcer disease should be treated with an iron rich diet.

Lactose Intolerance

Lactose intolerance is the inability to digest lactose, the sugar primarily found in milk and dairy product. Lactose intolerance has been recognized for many years as a common problem in many children and most adults throughout the world. Lactose intolerance is caused by the decreased production or absence of the enzyme lactase (beta D galactosidase). Lactose has an important role in human nutrition. It appears to enhance the absorption of several minerals, including calcium, magnesium, and zinc. It also promote the colonic growth of Bifidobacterium and is the sources of galactose, which is an essential nutrient for the formation of cerebral galactolipids.

Common symtoms of lactose intolerance which may range from mild to severe include nausea, cramps, bloating, flatulence, diarrhea. These symptoms of latose intolerance begin about 30 minutes to 2 hours after eating or drinking foods containing lactose. The severity lactose intolerance symptoms depends on many factors, including the amount of lactose a person can tolerate and a person's age, ethnicity, and digestion rate.

Medical nutrition with healthy food therapy
Lactose intolerance has no cure and no treatment can improve the body's ability to produce lactase, but symptoms on lactose intolerance can be controlled through diet management. Dietary control of lactose intolerance depends on
individual's learning through trial and error how much lactose the person can tolerate. The symptoms of lactose intolerance are alleviated by the following ways :
a. Dietary restriction
1. Avoidance of milk and other lactose containing foods
2. Foods containing lactose
Although milk snd fodds mode from milk are the only natural sources of lactose sugar, it is often added to prepared foods. Food product that may contain lactose are : breads and other baked goods, margarine, salad dressing, candies and other snacks, etc.
3. Lactose free formulas
4. Lactose free, lactose reduced milk

b. Oral lactase-replacement therapy
For those who react to very small amounts of lactose or have trouble to limit their lactose containing food intake, the lactase enzyme is available witout a prescription to help them digest lactose containing food. The lactase enzyme available as tablets are taken with the first bite of diary food.
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