Nutrition for Patients with Peptic Ulcer Disease
Peptic ulcer disease is a condition involving injury to the gastric or duodenal mucosa, causing uncomfortable symptoms such as abdominal pain, belching, heartburn, and nausea. Although some studies suggest that diet does not play a major role in directly causing or preventing ulcers [1], a proper diet can help reduce symptoms, support the healing of ulcers, and improve quality of life during treatment [2, 3].
1. The Process of Food Digestion
The digestive process begins when food enters the mouth and is mixed with saliva. In the stomach, food is churned and blended with gastric juice, a mixture containing hydrochloric acid and digestive enzymes. Hydrochloric acid plays a crucial role in destroying bacteria and initiating protein breakdown, while enzymes continue to cleave food into smaller particles. After being partially digested, food moves into the duodenum—the first part of the small intestine—where digestion and nutrient absorption continue.
2. What is Peptic Ulcer Disease?
Peptic ulcer disease is the occurrence of open sores or damaged mucosal areas in the inner lining of the stomach (gastric ulcers) or the upper part of the small intestine (duodenal ulcers) [3]. It is a chronic condition characterized by active and remitting phases [2]. Common symptoms include epigastric discomfort, a burning sensation, or persistent severe pain, which is often worse at night. Pain typically appears one to three hours after eating and may be accompanied by nausea, vomiting, digestive discomfort, bloating, and significant weight loss [2].
1. Causes of Peptic Ulcer Disease
Peptic ulcer disease has multiple causes, the most common of which include:
Helicobacter pylori (H. pylori) Infection
H. pylori is the primary cause of peptic ulcer disease [2, 3]. This bacterium can move in highly viscous environments, adhere to gastric mucosal epithelium, and protect itself. H. pylori infection plays a significant role in the pathophysiology of chronic gastritis and peptic ulcers in adults [2].
Use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
The long-term use of non-steroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, and naproxen is another common cause of ulcers [3]. These medications can damage the protective barrier of the gastric mucosa, leading to ulcer formation [2].
Lifestyle Factors (Stress, Smoking, Alcohol)
Smoking: Smoking reduces mucus and bicarbonate secretion, increasing the risk of ulcer formation [2, 3]. Nicotine exerts harmful effects on the protective mucous layer of the gastric epithelium [2].
Alcohol: Consuming alcohol damages the digestive tract, leading to ulcer symptoms and other alcohol-related conditions such as esophagitis, chronic pancreatitis, and gastritis [2, 3].
Stress: Stress can exacerbate ulcer symptoms and affect the ulcer healing process [2, 3].
1.1. Other Causes
Genetic factors can also play a role; for instance, children of individuals with duodenal ulcers have a threefold higher risk of developing the condition [2].
1.2. Nutritional Treatment Goals
The goals of nutritional therapy in treating peptic ulcer disease are:
1.3. Reduce acid secretion and protect the gastric mucosa
The diet should help lower gastric acid secretion to soothe pain and protect the stomach and duodenal mucosa from further irritation [2].
1.4. Support ulcer healing
Adequate nutrition promotes the regeneration and healing of damaged tissues [2].
1.5. Provide sufficient energy and nutrients
Ensuring adequate intake of macronutrients and micronutrients to maintain or restore the patient's nutritional status, which is especially important during acute and recovery phases [2].
1.6. Prevent recurrence and complications
A scientific diet helps reduce the risk of disease recurrence and limits complications such as gastrointestinal bleeding [2].
1.7. Nutritional Principles
To achieve the goals above, patients with peptic ulcer disease should follow these nutritional principles:
1.8. Eat on time and maintain regular meals
Eating on time helps maintain stable stomach activity and prevents the stomach from remaining empty for too long, which increases acid secretion. Avoid skipping meals and do not snack too late at night [3].
1.9. Split meals into smaller portions, eat slowly, and chew thoroughly
Dividing meals into 5 to 6 smaller portions a day instead of 3 large meals reduces the burden on the stomach, preventing overload and excessive acid stimulation [2]. Eating slowly and chewing thoroughly helps break down food better, reducing pressure on the stomach.
1.10. Choose soft, easily digestible foods
Prioritize boiled, steamed, stewed dishes, soups, and porridge. Avoid fried or stir-fried foods high in oil because they are hard to digest and can increase acid secretion [2, 3].
1.11. Limit gastric stimulants
Avoid foods and drinks that can cause discomfort, such as alcohol, coffee, carbonated soda, fatty foods, chocolate, and spicy foods [3].
1.12. Ensure food safety and hygiene
Food should be prepared cleanly and hygienically to avoid infection, especially with H. pylori or other bacteria that can worsen ulcer conditions.
1.13. Recommended Foods
Patients with gastric ulcers should prioritize the following foods:
1.14. Easily digestible starch group
- Easily digestible starches: Rice, porridge, potatoes, soft bread. These foods provide energy and are easy to digest. Oatmeal is a good choice because it contains soluble fiber, helping form a protective coating for the gastric mucosa [2].
- Whole grains: Brown rice, whole-wheat bread (if well-tolerated) can supply fiber.
1.15. Protein group
Protein sources: Lean meat, fish, eggs. These are easily digestible, low-fat protein sources that supply essential nutrients for ulcer healing [2].
Yogurt and fermented dairy: These products contain probiotics, which can help balance gut microbiota and reduce H. pylori bacterial load [2].
1.16. Healthy fats group
- Healthy fats: Olive oil, vegetable oils. Use these in moderate amounts for food preparation, avoiding deep-frying [2].
1.17. Vegetables and fruits
Dark green vegetables: Mustard greens, spinach, broccoli, etc., provide vitamins and minerals.
Pumpkin, potatoes, carrots: These root vegetables are soft, easy to digest, and can help neutralize acid.
Bananas, apples, papaya, cantaloupe: Low-acid, soft fruits rich in soluble fiber that are good for the stomach [2].
1.18. Beverages
Plain water (drinking enough water is very important).
Decaffeinated herbal teas (such as chamomile tea, which can help soothe the stomach).
1.19. Foods to Avoid
To prevent irritation and worsen ulcer conditions, patients should limit or avoid:
Sour, spicy, and hot foods:
Sour fruits: Oranges, lemons, grapefruit, pineapples, tomatoes have high acidity [2].
Spicy seasonings: Chili, pepper, ginger, garlic (in large amounts) can irritate the gastric mucosa [2, 3].
Pickled foods, salted vegetables: These contain acids and can increase gastric acid secretion.
1.20. Greasy, fried, and deep-fried foods
Fried dishes, fast food, fatty meats, sausages, and cured meats are hard to digest and can increase acid secretion [2, 3].
Alcohol, carbonated drinks, and caffeine:
Alcohol and beer: Damage the gastric mucosa and increase acid secretion [2, 3].
Carbonated soft drinks: Cause bloating, flatulence, and increase acid secretion [2, 3].
Coffee, strong tea: Stimulate gastric acid secretion; even decaffeinated coffee can cause this effect [2, 3].
1.21. Indigestible foods high in rough fiber
Vegetables and fruits with high rough, tough, or hard fiber content, such as bamboo shoots and raw greens (if not thoroughly processed), can be difficult to digest [2].
1.22. Processed and heavily seasoned foods
Canned items, instant noodles, and fast food often contain high amounts of salt, preservatives, and artificial seasonings, which are harmful to the stomach [2].
Regular medical check-ups and adherence to your doctor's treatment regimen are essential to ensure complete ulcer healing and prevent recurrence.
2. References
- [1] National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). (2022). Eating, Diet, & Nutrition for Peptic Ulcers (Stomach or Duodenal Ulcers). https://www.niddk.nih.gov/health-information/digestive-diseases/peptic-ulcers-stomach-ulcers/eating-diet-nutrition. Accessed: 2026-04-03.
- [2] VOMERO, N. D., & COLPO, E. (2014). Nutritional care in peptic ulcer. Arquivos Brasileiros de Cirurgia Digestiva: ABCD = Brazilian Archives of Digestive Surgery, 27(4), 284–288. https://pmc.ncbi.nlm.nih.gov/articles/PMC4743227/. Accessed: 2026-04-03.
[3] MedlinePlus. (2025). Peptic ulcer disease - discharge.
https://medlineplus.gov/ency/patientinstructions/000380.htm. Accessed: 2026-04-03.
The information above is for reference purposes only and is not intended as medical advice. Please contact your doctor for detailed medical consultation.