Before talking of ulcer and diet that we have to be taken, it's a right way to speak and describe the

organs involved in this disease:

- The Stomach

- The Duodenum

The Stomach
The stomach is a muscular, hollow, dilated part of the alimentary canal which functions as an important organ of the digestive tract. It is involved in the second phase of digestion, following mastication (chewing). The stomach is located between the oesophagus and the small intestine.

The Stomach wall

The stomach walls are made of the following layers, from inside to outside
The first main layer. This consists of the epithelium and the lamina propria (composed of loose connective tissue), with a thin layer of smooth muscle called the muscularis mucosae separating it from the submucosa beneath. This layer lies over the mucosa and consists of fibrous connective tissue, separating the mucosa from the next layer. The Meissner's plexus is in this layer. Over the submucosa, the muscularis externa in the stomach has three layers of smooth muscle muscularis externa inner oblique layer middle circular layer outer longitudinal layer serosa This layer is over the muscularis externa, consisting of layers of connective tissue continuous with the peritoneum. mucosa

submucosa

Glands of Stomach
The epithelium of the stomach forms deep pits. The glands at these locations are named for the corresponding part of the stomach: Cardiac glands (at cardia) Pyloric glands (at pylorus) Fundic glands (at fundus)

The Stomach Gland s Cell and their Secretions

Different types of cells are found at the different layers of these glands:
Layer of stomach Isthmus of gland Body of gland Base of gland Base of gland Name Mucous and mucoid cells parietal (oxyntic) cells chief (zymogenic) cells enteroendocrine (APUD) cells Secretion mucus gel layer gastric acid and intrinsic factor pepsinogen hormones gastrin, histamine, endorphins, serotonin, cholecystokinin and somatostatin Region of stomach Fundic, cardiac, pyloric Fundic, cardiac, pyloric Fundic only Fundic, cardiac, pyloric

GASTRIC GLAND

GASTRIC Juice
Hydrochloric acid Pepsin Intrinsic factor
1. 2. 3. 4. Mucosal cells Mucoid cells Parietal cells Chief cell

The Duodenum
The duodenum is the first section of the small intestine. The duodenum precedes the jejunum and ileum and is the shortest part of the small intestine, where most chemical digestion takes place. In humans, the duodenum is a hollow jointed tube about 10 12 inch long connecting the stomach to the jejunum. It begins with the duodenal bulb and ends at the ligament of Treitz.

Duodenum parts
First part (superior) begins as a continuation of the duodenal end of the pylorus. Then 5cm it curves inferiorly into the superior duodenal flexure (the end of the superior part). begins at the superior duodenal flexure. At the end turn medially into the inferior duodenal flexure (the end of the descending part). begins at the inferior duodenal flexure and passes transversely to the left, crossing the right ureter. reaches the inferior border of the body of the pancreas. Then, it curves anteriorly and terminates at the duodenojejunal flexure where it joins the jejunum. The duodenojejunal flexure is surrounded by a peritoneal fold containing muscle fibres: the ligament of Treitz.

Second part

(descending)

Third part

(inferior/horizontal)

Fourth part

(ascending)

Ulcer
Definition
Destructive process of the mucous membranes and underlying layers, common in the stomach and duodenum, caused by the damaging action of chloride-peptic secretion
Other locations: distal esophagus, post-anastomotic jejunal loop, Meckel's diverticulum

Positions of Ulcers
STOMACH: on top of small curvature, in intermediate portion between the body and pyloric antrum DUODENUM: commonly in the bulb, immediate near the pylorus

Most common causes of Ulcers

Infection by Helicobacter Pylori (After 1980) Gastric acid hypersecretion Stress Smoke

almost every time, an acute gastric mucosal lesions is caused by the use or abuse of anti-inflammatory drugs, including aspirin, that is acetylsalicylic acid or other (indomethacin, ibuprofen, naproxen, tolmetin, sulindac, piroxicam, fenoprofen). In these cases in the patient, since the drug is absorbed through backscattering in the gastric mucosa, there are superficial antral erosions with bleeding.

The most common sintoms

difficulty in swallowing food; nausea and vomiting; vomiting of blood coagulation; loss of weight; tiredness; severe abdominal pain.

Gastric Ulcers
very important is the differential diagnosis with stomach cancer the ulcer was confirmed by endoscopic examination and radiological the first symptom is commonly represented by epigastric pain. antacids provide prompt relief, while food, after a temporary wellness, can induce growth.

Duodenal Ulcer
The pain typically appears from 1 to 3 hours after a meal (late) An ingestion of food results in a resolution of pain in a short time A typical seasonal increase in spring and autumn

Clinical Differences
STOMACH: -older age - decreased motility - reduced secretion at rest -DUODENUM: - more sensitive to the resting basal stimulus - regress with food

Complications of Ulcers

Hemorrhage Perforation (the most common site duodenum) Pyloric stenosis Malignant degeneration (1-5% of gastric cases caused by Helicobacter Pylori)
Malignant ulcer: endoscopic view of cancer

Therapy
Before talking about the diet in case of ulcer, shown the severity of the disease, is right to say a word about medical treatments, which are much more timely and useful MEDICAL THERAPY In about of patients with ulcer, medical treatment (antacids, histamine H2 receptor antagonists, proton pump inhibitors, somatostatin) is sufficient to stop the bleeding and stabilize the condition. The placement of a nasogastric tube of large caliber allows flushing of the stomach, the aspiration of blood clots, and monitoring any resumption of bleeding. The electrocoagulation, a lasercoagulation, tissue adhesives, fibrin glue, collagen can be useful sometimes decisive. In patients infected by Helicobacter pylori will be associated an antibiotic therapy.

Surgical Therapy
25% of patients with an acute ulcer still requires the use of emergency surgery. The surgery is aimed first of all to identify and arrest (by suturing / or ligation) the source of hemorrhage. After, it's possible to proceed to one of the surgical treatment valid for ulcer: Vagotomy simple Vagotomy + antrectomy (with Reset of gastrointestinal continuity).

Diet for Ulcera

Gastric ulcer belongs to a category of diseases for which it described a diet that reduces the secretion of stomach acid and avoid excessive mechanical distension of the stomach wall. There are many herbal and homeopathic remedies for the treatment of peptic ulcer. But if the disease is not treated, it can give serious complications. So they should be taken under medical supervision.

The diet in case of ulcer is a diet low in vitamins B1, C, calcium and iron. It can be used in case of gastric and duodenal ulcer, bleeding or healing phase). In general, the diet for an ulcer is governed by the following points: eat at regular intervals, variety of foods, exclude irritant and stimulants foods for of the secretions of the stomach. Other suggestions: Eat slowly, chewing carefully Have a snack between main meals and before bedtime Avoid heavy meals (with the ulcer is better to eat little but often) Avoid tea, coffee, alcohol, fried foods, fatty cheeses, fatty meats, spices

Ulcers: The "Good" foods

Bread toasted, dry, crust of bread, crackers, bread sticks, rusks, biscuits, rice, pasta, semolina, corn, cream of vegetables and legumes, pasta with olive oil and fresh tomatoes) drinking milk or in various foods (mashed potatoes, cakes, cream, white sauce ...). Unfermented fresh cheese (mascarpone, mozzarella, smoked cheese, crescenza), boiled eggs, poached, even as an ingredient in other preparations, but not fried. Lean veal, chicken, rabbit, pork, lean, leg of lamb, and ham. Fresh fish lean boiled or grilled or baked (sole, trout, perch and hake, sea bass, sea bream) never fried.

Ulcers: The "Good" foods

Vegetables: vegetable soups in general, potatoes (not fried), lettuce, artichoke hearts, cooked carrots, red beets, small peas cooked and mashed, beans, tomatoes (skinned and seeded), finely chopped celery. Fruit cooked and mashed fresh fruit ripe, peeled and seeded. Beverage: barley coffee and only after meals, non-carbonated water, various teas, non-acidic fruit juices diluted with water. Sweets: sugar, fruit cakes, meringue, candy, dry biscuits, fruit jellies, butter, olive oil, aromatic herbs, lemon juice instead of vinegar.

Ulcers: The "Good" foods

Liquorice
The main Property of the extracts of liquorice root is its cytoprotective, antiinflammatory and healing activity on gastric and duodenal mucosa. All this is due in particular to the glycyrrhizin, which acts by direct contact with the lesion, and with an indirect stimulus to production of mucus by the cells of the gastric wall. Liquorice is very specified in the prevention and treatment of gastric and duodenal ulcers, gastritis and ulcer caused by drugs (NSAIDs, steroids).

Ulcers: The "Good" foods

Cabbage
Cabbage Fights gastric ulcer, duodenal ulcer and intestinal ulcers

Ulcers: The "Good" foods

Kohlrabi
Kohlrabi fights gastric ulcer, duodenal ulcer and intestinal ulcers

Ulcers: The "Good" foods

Potatoes Juice
This juice is precious for its properties: It is efficient for cases of gastric and duodenal ulcer.

A new Discovery!
A recent study, published on the world-magazine of gastroenterology, discovered the protective effects of arugula about gastric and duodenal ulcer in an animal model (mouse). Although the prickly taste, the arugula protected the mice's stomach from damage, induced by alcohol and indomethacin. The results are very good, and certainly should be detailed on man before take conclusions.

Ulcers: The Bad foods

Fresh bread: soft part or undercooked bread , rye bread, wholemeal flour, fat soups or whit whole vegetables, soups with fried, soup with meat broth, seasoned pasta too much seasoned with sauces and spices. Condensed milk, cold milk, cheese or spicy fermented. Fried eggs, omelet fried. Fatty meats and meats served with sauces, preserved in salt, smoked, not cooked, fried, stews, casseroles, roasts, fat pork, mutton, venison, goose, duck, turkey, salami, Bologna sausage, sausages. Fatty fish: sardines, herring, anchovies, eel, salmon, cod. All preparations fried, smoked, dried, salted

Ulcers: The Bad foods

All nuts, figs, bananas, chestnuts, oranges, tangerines, grapes, dates, walnuts, almonds, hazelnuts, sour fruit, all just ripe fruit. Pure wine, beer, all carbonated drinks, carbonated water, tea, concentrated coffee, especially with empty stomach, liqueurs and alcoholic drinks, all the frozen drinks, all liquids are too hot, acidic fruit juices (lemon, grapefruit, orange, apricot). fried Sweet, stuffed, made with puff pastry, with cream, cocoa, chocolate, ice cream, sorbets. All cooked fat, especially if cooked longer, fried foods, lard, all the spices, mustard, vinegar. All stored and fermented food.

An example of 1600 calorie diet for Ulcers

Breakfast 200 ml of milk or yogurt or barley coffee with one packet of sugar 2 slices toast with honey or 30 grams. bread Lunch 60 gr. rice or pasta, or semolina or cream of rice cooked in milk with a knob of butter 140 gr. veal or grilled scallops, or 140 gr. chicken in the oven or 210gr. sole in white or 2 eggs 200 gr. zucchini (or carrots or green beans), steamed 30 gr. unsalted bread 150 gr. baked apples or pears or fresh fruit ripe Break 2 slices with 30 gr. of jam and a cup of decaffeinated tea or coffee barley Dinner 35 gr. rice or noodles in vegetable broth or cream of rice milk (200 ml) 60 gr. of mozzarella cheese or soft cheese or 2 eggs or 120 grams. of ricotta cheese Mashed potatoes and carrots 2 slices bread or bread sticks