Q. Different stages involved in feeding patient - peptic ulcer?

Stage I: It is characterized by haematemesis (vomiting of blood which may be derived from mouth, stomach, oesophagus or duodenum or melena (passage of black tarry stools indicative of GI bleeding). Initially, for bleeding ulcer, if the patient is extremely nauseated or vomiting, he must be kept on NBM (nil by mouth). This is followed by an hourly feeding to begin with. Milk and cream 100 g hour (especially in stages of acute pain) followed by small feedings of easily digestible foods like soft cooked eggs, custards, refined flour products, cottage chkese, low fibre vegetables like gourds, clear soup with no seasoning and herbs, soft over ripe fruit whips and light desserts. The diets must be fed orally, and of liquid I semi liquid I soft consistency, which is easy to digest.

Stage II: The characteristics of this stage involves -

• Marked recovery from pain.

• G meal pattern followed

• light, bland, low fibre diet

• mechanical/thermal, chemical irritation of gastric mucosa to be avoided

• Late night feeding avoided, as the end products of digestion may cause the epigastric pain.

Stage 111: In this stage, following characteristics are involved -

• number of feeds reduced to 3-4, as recent studies show no benefit in terms of gastric acid secretion

• discharged from hospital

• increased amount / feed

Stage IV: This stage involves -

• Liberalizing the diet depending on the patient's individual tolerance and schedule.

• Ensuring optimum intake of calorie, protein, fats, vitamins and minerals.

• Relaxed atmosphere on eating.

• lifestyle change (stress, alcohol, caffeine, smoking )