Gastritis and Peptic Ulcer Disease: Nutritional Considerations

For decades, doctors have recommended dietary adjustments aimed at preventing or treating symptoms of gastritis and PUD. Common suggestions have included avoiding spicy foods, coffee, and alcohol, and increasing consumption of bland foods and milk. While these suggestions seem reasonable, some have not stood up well in controlled investigations. For example, milk ingestion tends to increase gastric acid secretion.⁶ Although certain spices (black pepper, chili powder, red pepper) may cause dyspepsia,⁶ they have not been shown to contribute to either gastritis or peptic ulcer.

Diet may moderate the risk for gastritis or peptic ulcer through acting on H pylori, among other effects.⁷ The following factors have been associated with reduced risk of gastritis or ulcer disease in epidemiologic studies:

High–fiber diets. A large cohort study at the Harvard School of Public Health found that high–fiber diets were associated with reduced risk for developing duodenal ulcer. Over a 6–year period, the risk was 45% lower for those with the highest fiber intake, compared with those with the lowest. Food sources of soluble fiber (oats, legumes, barley, certain fruits and vegetables) were especially protective, resulting in a 60% lower risk for this group.⁸ However, supplementation with dietary fiber in the form of wheat bran had no effect on ulcer recurrence.⁹ Similarly, high–fiber diets did not appear to increase ulcer healing rates, compared with diets low in fiber.¹⁰

Diets high in vitamin A. In the same Harvard cohort study, total vitamin A intake (from food and supplements) was associated with lower risk. The risk was 54% lower among persons consuming the most vitamin A, compared with those consuming the least.¹¹

Green tea. Several studies show that regular green tea consumption is associated with a 40% to 50% lower risk for gastritis.¹² Cellular tests suggest that the catechins in green tea (eg, epigallocatechin–3–gallate, EGCG) may suppress H pylori–induced gastritis through antioxidant and antibacterial actions.¹³ However, current evidence is not yet sufficient for recommending green tea for prevention of gastritis.

Avoiding alcohol. The relationship between alcohol and gastritis and peptic ulcer is complex, and may be related to amounts consumed. Chronic alcohol abuse favors H pylori infection, and the ammonia produced by this organism contributes to gastritis.¹⁴ Alcohol may also slow the rate of healing in established ulcers,¹⁵ although this has not been demonstrated in patients on proton pump inhibitors.

However, studies have also found an inverse association between moderate alcohol consumption and H pylori infection. Alcohol may have bactericidal effects on H pylori,¹⁶ and it may prevent infection and associated gastritis through an adaptive cytoprotective response (eg, endogenous release of prostaglandins with protective effects on gastric mucosa).¹⁷ But, while moderate consumption was associated with the lowest odds for infection, higher intakes were associated with greater risk.¹⁸ The protective effect of moderate alcohol consumption for gastritis and PUD is not evident among smokers; in combination with smoking, alcohol increases the risk for duodenal ulcer.¹⁹

In addition, the following are under study for their role in managing gastritis and PUD:

Avoiding coffee. Coffee, either in its caffeinated or decaffeinated forms, stimulates acid secretion,⁸ and some studies have suggested a correlation between coffee intake and symptoms in patients with duodenal ulcer.²⁰

Coffee consumption may also mediate the relationship between H pylori infection and ulcer, although studies have variously found coffee consumption to be associated with both increased and decreased risk for H pylori infection.^21–23 Overall, there is no current evidence implicating coffee consumption in the susceptibility to, treatment of, or recovery from gastritis.

Probiotics. Probiotics (eg, Lactobacillus caseii) interfere with H pylori adhesion to epithelial cells, attenuate H pylori–induced gastritis,²⁴ and inhibit growth of H pylori in humans, in addition to reducing the side effects of eradication treatment.²⁵ Combining probiotic treatment with omeprazole, amoxicillin, and clarithromycin in H pylori–infected children significantly improved the treatment effectiveness, compared with drug treatment alone.²⁶ Further study is needed to determine if probiotic treatment results in the prevention of initial infection, reduction of gastritis symptoms, prevention of ulcer occurrence, and improved healing of gastric lesions.

Orders

See Basic Diet Orders chapter.

Alcohol restriction.

Smoking cessation.

Stress reduction.

Exercise prescription.

What to Tell the Family

Bacterial infection plays a significant role in PUD, and testing and treatment for H pylori are important. In addition, the risk for developing gastritis and ulcer disease may be reduced by following a healthy diet and exercise regimen and properly managing stressful life circumstances. In patients with existing disease, these methods should be used along with medications to reduce acid secretion, speed ulcer healing, and eradicate the bacteria that often cause this disease.