Review on Peptic ulcer and its effective Management and Treatment with Herbals

 

Manisha Bhatti¹, Divya Dhawal Bhandari¹*, Jitender Singh²*

¹University Institute of Pharma Sciences, Chandigarh University, Gharuan, Mohali-140413, Punjab, India.

²Professor and Principal, Institute of Pharmaceutical Sciences, IET Bhaddal Technical Campus, Bhaddal, Distt. Rupnagar, Punjab-140108.

 

ABSTRACT:

Peptic Ulcer Disease (PUD) is one of the major problems of the gastrointestinal tract occurs in the stomach, duodenum and oesophagus. PUD is characterized by mucosal damage either by pepsin, gastric acid secretion or bacterial infection. Apart from infection due to gram negative bacteria-Helicobacter pylori, regular consumptions of the medications like, NSAIDS, steroids and excessive stress are also some major causes of the PUD.  Complications of PUD may include bleeding, perforation, and blockage of the stomach. The PUD is an emerging health challenge in the developed and developing countries. Commonly use of potent synthetic antiulcer chemotherapy arises with adverse effects that might be a cause of serious health challenge. Traditional utilization and scientific reports of medicinal plants in the management of peptic ulcer-like-symptoms urge to redesign the existing clinical approach of using synthetic drugs for the treatment of PUD and adopt the scientifically proven plant drugs for the treatment of PUD which might free or have lesser adverse effects as compared to the synthetic chemotherapy. The review might bestow a strategic planning for the treatment of PUC to the medical practitioners and a newer scope to the researchers to explore the traditional claims of the plant drugs.

 

 

 

INTRODUCTION:

PUD is a worldwide issue. About 4 million population suffering from this disease in the United States and approx. 3.6 lakh new cases are reported each year. (Boss et al 2003). Ulcers are defined as an open sore of the skin or mucus membrane (Huang et al 2002). Helicobacter pylorus bacteria is known responsible for major duodenal ulcers and of gastric ulcers. (Malik et al 2018, Huang et al 2002).

 

Ulcers mostly occur on the skin of the lower extremities and in the gastrointestinal tract. It is a kind of sore that grows in the food pipe of body. Gastric ulcer is predominantly found in old age population (Chan et al 2004). Duodenal ulcers are mostly seen at the upper part of small intestine (Venkateswaramurthy et al 2011). Duodenal ulcers occur inside the oesophagus and are more common in younger individuals. Duodenal ulcers may appear on both the anterior and posterior walls of duodenum (Umbare et al 2011).

 

Peptic ulcer with symptoms like blood in stool, extreme abdominal pain. This is due to an imbalance between aggressive and defensive factors of body of stomach linings (Mariam et al 2018) (Vyawahare et al 2009) Bacterial infection particularly H. pylori, a Gram-negative bacterium which found in the mucous layer and the gastric epithelium is the common cause of ulcer formation. (Patel et al 2013). The other reason of ulcer formation is excess medications, particularly non-steroidal anti-inflammatory drugs, excess acid production, excessive drinking of alcohol, smoking or chewing tobacco, serious illness, radiation treatment to the area, emotional stress, etc.    Figure 2 shows the protective and aggressive factors of PUD.

 

Common chemotherapy used for the treatment of peptic ulcers includes the agents that reduce gastric acidity or promote mucosal defence like, H₂ antihistamines, Proton pump inhibitors, Anticholinergics, Prostaglandin analogue, Antacids, Ulcer protectives, Anti-H. Pylori drugs. These drugs have some severe adverse effects (Brooks 1985, Tripathi 2014, Goodman et al 2011).

 

Figure 1: (A) Healthy gastric mucosa: Equilibrium between mucosal aggressive and protective factors. (B) Gastric ulcer formation: Inadequacy between mucosal aggressive and protective factors. (C) Images of Healthy Stomach, Stomach Ulcer and Duodenal ulcer (Chan et al 2004, Vyawahare et al 2009)

 

1.1 Interventions of Plant Drugs in Pud:

Traditional utilization of plant drugs have been an approach for the management of peptic ulcer type symptoms since the ancient times. Plant based remedies are a reliable source of PUD treatments with lesser or no side effects (Akshaya et al 2019). This has been the method of reasoning for the advancement of new plant-based medications in the chemotherapy of peptic ulcers diseases to align with the synthetic drug therapy, which have a number of adverse effects (Goodman et al 2011) Many plant drugs have reported to posse’s significant Antipeptic ulcer activity using in-vitro and in-vivo animal experimental methods. Plant drugs contain a variety of primary and secondary class of metabolites like, flavonoids, tannins, alkaloid, glycoside, terpenoid, steroid, saponin and many others. The peptic ulcer effect of herbal drugs might be due to a single bioactive principle present in the plant drug or synergistic effect of secondary metabolites. Some bioactive molecules also have isolated in plant studies and found potentials antiulcer candidate (Grossman 2009, Van Zanten et al 1999, Tytgat 2011). Table 1 contains list of potential plant drugs reported to have antiulcer activity. 

 

Table 1: Plant drugs reported to possess Antiulcer Properties.

Plant Common Name Scientific Name [Family]	Plant part Bioactive extract	Dose	Animal Model	Phytoconstituents Present	Reference
Babul Acacia arabica [Mimosaceae]	Bark Aqueous extract	200mg/kg; orally	Swimming stress induced and Ulcer model NSAID induced	Phenolic components	(Bansal et al 2012, Omayma et al 2011)
Bael Aegle marmelos [Rutaceae]	Leaves Aqueous extract	1gm/kg; orally	Alcohol and Aspirin induced Ulcer model	Alkaloids like aegelenine and aegeline, coumarins and tannins.	(Subitha et al 2011, Ilavarasan et al 2002)
Large cardamom Amomum subulatum [Zingiberaceae]	Fruits Ethyl acetate soluble fraction	196mg/kg; orally	Aspirin and ethanol induced Ulcer model	Essential oils	(Jafri et al 2001, Mohamed et al 2011)
Garlic Allium sativum [Liliaceae]	Bulb Juice extract	250/500mg/kg; orally	Cysteamine intoxicated	Essential oil, allinase, and allicin	(Azamthulla et al 2009)
Aloe vera Aloe Barbadensis Miller [Liliaceae]	Leaves	200mg/kg; orally	Indomethacin intoxicated gastric Ulcer model	barbaline, isobarboline, and saponins	(Borra et al 2011)
Sugar apple  Annona squamosa [Annonaceae]	Leaves Aqueous extract	250/500mg/kg; orally	Ulcer model Ethanol Induced	Alkaloids, flavonoids, steroids, saponins, tannins	(Saleem et al 2012)
Neem Azadirachtaindica [Meliaceae]	Leaves Aqueous extract	600mg/kg; orally	Indomethacin induced Ulcer model	Isomeldenin, nimbin, nimbinene, and quercetin, tannins and oil	(Divakar et al 2001)
Cerrado Anacardium humile St. Hil. [Anacardiaceae]	Leaves Ethyl acetate extract	50mg/kg; orally	Ethanol-induced Ulcer model	Gallic acid derivatives, catechins and flavonoids	(Ferreira et al 2010)
Cashew nut Anacardium occidentale [Anacardiaceae]	Leaves Hydroalcoholic extract	400mg/kg; orally	HCl/ethanol induced Ulcer model	Flavonoids, mainly quercetin glycosides and saponins	(Mohamed et al 2011,
Kachnar Bauhinia variegate [Caesalpiniaceae]	Roots Ethanol extract	400 mg/kg; orally	Ulcer model Ethanol, and Aspirin induced	Quercetin, rutin, apigenin, and apigenin 7-0-glucosid	(Kumar et al 2011)
Indian barberry  Berberis vulgaris [Berberidaceae]	Seeds Ethanol extract	300mg/kg; 600 mg/kg; 900 mg/kg; orally	Aspirin induced Ulcer model	Alkaloid “berberine	(Majeed W et al 2015)
Flame of the forest Butea frondosa (Roxb.), [Fabaceae]	Leaves Chloroform extract	250mg/kg; orally	0.6 M HCl induced Ulcer model	Flavanoids, terpenoids and lipid constituents	(Londonkar et al 2010)
Slow match tree Careyaarborea [Myrtaceae]	Stem bark Ethanol extract	600mg/kg; orally	Ethanol induced ulcer, Pylorus ligation induced Ulcer model	Tannins and saponins	(Kumar et al 2013)
Papaya Carica papaya [Caricaceae]	Seeds Aqueous extract	100 mg/kg; orally	Aspirin induced gastric ulcer model	Papain, chymopapain, pectin, carotenoids	(Kottaimuthu et al 2008, Indran et al 2008)
Cucumber Cucumis sativus [Cucurbitaceae]	Fruit pulp Hydroalcoholic extract	500mg/kg; orally	Pyloric Ligation Ulceration, Indomethacin and ethanol Induced Ulcer model	Flavonoids, tannins and triterpenes	(Narra et al 2015)
Coconut Cocus nucifera L. [Arecaceae]	Seeds Ethanol extract	200mg/kg; orally	Ethanol induced , ethanol/HCl induced , ibuprofen and ischemia/reperfusion induced Ulcer model	Flavonoids, tannins and triterpenes	(Anosike et al 2010)
Ivy gourd Coccinia grandis Linn. [Cucurbitaceae]	Leaves Methanol and aqueous extract	500mg/kg; orally	Aspirin induced gastric ulcer model	Phenol, Flavonoids, Terpenoids	(Mazumder et al 2008)
Kapok Ceiba pentandra G. [Bombacaceae]	Bark Aqueous extract	400mg/kg; orally	Indomethacin Induced Ulcer model	Flavonoids Terpenoids and Phenolic Components	(Ibara et al 2007)
Sugpon-sugpon Cissus quadrangularis L. [Vitaceae]	Stem Methanol extract	1000mg/kg; orally	Aspirin induced gastric ulcer model	Flavonoids, Terpenoids	(Shanthi et al 2010)
Mofumbo Combretum leprosum M. and E. [Combretaceae]	Stem bark Ethanol extract	250mg/kg; orally	Ethanol and indomethacin Induced Ulcer Model	Triterpenes, flavonoids, taninns and saponins	(Nunes et al 2009)
Cipó-Caboclo Davilla rugosa [Dilleniaceae]	Stems Hydroalcoholic extract	800mg/kg; orally	HCl/ethanol induced ulcers; immersion-restraint stress induced Ulcer model	Triterpenes, flavonoids, tannins and saponins	(Mohamed et al 2011)
Paraíba Encholirium spectabile Mart. [Bromeliaceae]	Aerial parts Ethanol extract	100mg/kg; orally	Absolute ethanol, ethanol/HCl, ibuprofen and ischemia/reperfusion induced Ulcer model	Triterpenes, flavonoids, tannins and saponins	(Carvalho et al 2010)
Mangrove Excoecaria agallocha L. [Euphorbiaceae]	Bark Aqueous Extract	125mg/kg; orally	NSAID induced Ulcer Model	Triterpenes, tannins, flavonoids, tannins and saponins	(Thirunavukkarasu et al 2009)
Indian coral tree Erythrina indica L. [Febaceae]	Leaves Methanol extract	500mg/kg; orally	Pylorus ligated and indomethacin induced ulceration models	Triterpenes, flavonoids, tannins, phenol	(Sachin et al 2009)
Sacred fig Ficus religiosa [Urticaceae]	Leaves Hydroalcoholic extract	500 mg/kg; orally	Stress induced ulcer animal models	Flavonoids	(Gregory et al 2013, Saha et al 2010)
Malabar tamarind Garcinia cambogia Desr. [Clusiaceae]	Fruit Extract	500mg/kg; orally	Indomethacin Induced Ulcer model	Flavonoids, sterols, glycosides	(Dos et al 2009)
Liquorice Glycyrrhiza glabra L. [Fabaceae]	Seed Ethanol extract	200mg/kg; orally	Indomethacin-induced Ulcer model	Flavonoids, sterols, glycosides	(Ligha et al 2009)
Roth's spike thorn Gymnosporia rothiana (W.) [Celastraceae]	Leaves Methanol extract	500mg/kg; orally	Ethanol and indomethacin induced gastric ulcer models	Phenol, Triterpenes, tannins, flavonoids, tannins and saponins	(Jain et al 2009)
Sambung nyawa Gynura procumbens (Merr.) [Asteraceae]	Leaves Ethanol extract	400mg/kg; orally	Aspirin induced gastric ulcer model	Flavonoids	(Mahmood et al 2010)
African beech Helicrysum mechowianum K. [Asteraceae]	Leaves Aqueous extract	400mg/kg; orally	Indomethacin induced gastric ulcer model	Flavonoids	(Ibara et al 2007)
Changing rose Hibiscus rosa sinensis [Malvaceae]	Leaves Ethanol extract	500 mg/kg; orally	Pyloric ligation induced gastric Ulcer model	Sterols, glycosides, proteins, mucilage and flavonoids	(Srivastava et al 2013)
Pau Santo Kielmeyera coriacea [Guttiferae]	Stems Aqueous suspension	120mg/kg; orally	Ethanol-acid, acute stress and Indomethacin Ulcer model	Sterols, Phenols, Flavonoids	(Goulart et al 2005)
Chaparral Larrea divaricata Cav. [Zygophyllaceae]	Leaves Methanolic extract	300mg/kg; orally	Absolute ethanol and HCl 0.6N induced Ulcer model	Phenols, Flavonoids	(Mohamed et al 2011, Pedernera et al 2006)
Flaxseed or linseed Linum usitatissimum  [Linaceae]	Seed oil and mucilage	Oil: 5.0ml/kg; p.o. and mucilage: 10.0 ml/kg, orally	Ethanol-induced gastric Ulcer model	Flavonoids, Phenols,	(Dugani et al 2008)
Chesters fide JMD Lasianthera Africana P. B. [Icacinaceae]	Leaves Ethanol extract	1000mg/kg; orally	Ethanol-induced, indomethacin-induced and reserpine-induced ulcer Model	Flavonoids	(Okokon et al 2009)
Mango tree Mangifera indica [Anacardiaceae]	Flower decoction	500mg/kg; orally	Acid alcohol induced ulcer Model	Tannins, flavonoids	(Neelima et al 2012)
Touch me not Mimosa pudica [Fabaceae]	Leaves Ethanolic extract	400mg/kg; orally	Indomethacin induced Ulcers Model	Flavonoids and phenolic Compounds	(Vinothapooshan et al 2010)
Bitter gourd Momordica charantia [Cucurbitaceae]	Leaves Ethanol extract	200mg/kg /400 mg/kg; orally	Pylorus Ligation, Aspirin, stress Induced Ulcer Model	Saponins, Sterols, Mucilage, glycosides, alkaloids, steroidal saponins	(Rao et al 2011)
Drumstick tree Moringa oleifera [Moringaceae]	Leaves Ethanol extract	500mg/kg; orally	Aspirin induced peptic Ulcer model	Saponins, Sterols, flavonoids	(Kumari et al 2011)
Chamomile  Matricaria chamomilla L. [Asteraceae]	Flowers Aqueous extract	400mg/kg; i.p.	Ethanol-induced, indomethacin-induced and reserpine-induced ulcer models	Flavonoids and phenolic Compounds	(Karbalay-Doust et al 2009)
Mulberry  Morus alba L. [Moraaceae]	Leaves Ethanol extract	500mg/kg doses, orally	Absolute ethanol induced ulcer model	Flavonoids and phenolic Compounds	(Abdulla et al 2009)
Peppermint Mentha arvensis L. [Lamiaceae]	Leaves Aqueous extracts	375mg/kg; orally	Ibuprofen plus pyloric ligation, 0.6 M HCl induced and 90% ethanol-induced ulcer models	Flavonoids and phenolic Compounds	(Londonkar et al 2009)
Black Cumin Nigella sativa [Ranunculaceae]	Seeds Aqueous suspension	500mg/kg; orally	Indomethacin-induced gastric mucosal Ulcer model	Fixed oil, volatile oil	(Mofleh et al 2008)
Holy basil Ocimum sanctum [Lamiaceae]	Leaves Fixed oil	2ml/kg; i.p.	Aspirin, indomethacin and alcohol induced ulcer models	Fixed oil eugenol	(Singh et al 1999)
Rice/Paddy Oryza sativa [Gramineae]	Bran Extract of rice bran oil	400mg/kg orally	Ethanol-induced acute gastric ulcer models	Gamma oryzanol	(Panchal et al 2008)
Tulipa/Rock pine Orostachys japonicus A. B. [Crassulaceae]	Aerial Parts Methanol extract	100mg/kg; orally	HCl/ethanol-induced and indomethacin/bethanechol-induced ulcer models	Triterpene-rich and flavonoid-rich	(Ju Jung et al 2007)
Stonebreaker  Phyllanthus niruri [Euphorbiaceae]	Aerial parts Methanolic extract	400mg/kg; orally	Ethanol-acid induced gastric Ulcer model	Carbohydrates, triterpenoids, alkaloids, glycosides, tannins, flavonoids, essential oils	(Okoli et al 2009)
Spogel Plantago ispagula [Plantaginaceae]	Leaves Aqueous extract	2 to 3 drachms; orally	Ethanol-acid induced gastric Ulcer model	Mucilage, fixed fatty oil, and albuminous matter	(Nadkarni's et al 1976)
Guava Psidium guyava [Myrtaceae]	Leaves Methanol extract	500mg/kg; orally	Ethanol induced gastric ulcer model	Quercetin, guaijaverin, flavonoids, and galactose-specific lecithins	(Uduak et al 2012)
False Ashoka/Buddha tree  Polyalthia longifolia (Sonn)  [Annonaceae]	Leaves Ethanol extract	300mg/kg; orally	Aspirin induced ulcer, HCl–ethanol induced and stress induced ulcer models	Flavonoids and terpenoids	(Malairajan et al 2008)
Visgueira parkia Platycephala Benth. [Leguminosae]	Leaves Ethanol extract	250mg/kg; orally	Ethanol and ethanol-HCl induced Ulcer Model	Flavonoids, Saponins and tannins	(Fernandes et al 2010)
Amargo Quassia amara L. [Simaroubaceae]	Bark Ethanol extract	100mg/kg; orally	Indomethacin-induced gastric ulcer Model	quassin and 2-methoxycanthin-6-one	(Garcia-Barrantes et al 2011)
Pau terra Qualer grandiflora [Vochysiaceae]	Bark Hydroalcoholic extract	500mg/kg; orally	HCl/ethanol Induced ulcer Model	terpene, steroid, saponin, phenolic compound and tannin	(Hiruma-Lima et al 2006)
Red mangrove Rhizophora mangle L. [Rhizophoraceae]	Bark Aqueous extract	500mg/kg; orally	Ethanol-hydrochloric acid Induced Ulcer Model	Flavonoids and tannins	(Sanchez et al 2001)
Sumach Rhus coriaria [Anacardiaceae]	Grains Hydroalcoholic extract	248mg/kg; orally	Ethanol induced gastric ulcer model	Flavonoids and tannins	(Ahmad et al 2013)
Licorice weed Scoparia dulcis L. [Plantaginaceae]	Aerial parts Aqueous extract	500mg/kg; orally	Indomethacin-induced Ulcer Model	Flavonoids and Sterols	(Mesia-Vela et al 2007)
Basna Sesbania grandiflora [Fabaceae]	Leaves Ethanol extract	400mg/kg; orally	Aspirin induced, ethanol induced ulcer model, and indomethacin induced ulcer models	Tannins and saponins	(Ganesan et al 2008, Bhalke et al 2010)
Sal tree  Shorea robusta [Dipterocarpaceae]	Resin extract	300mg/kg; orally	Ethanol induced ulcer model and pylorus ligation induced ulcer models	triterpenic acid, tannic acid and phenolic content, Ursolic acid and amyrin	(Kumar et al 2013)
Black nightshade berries Solanum nigrum [Solanaceae]	Leaves Aqueous extract	200mg/kg; orally	Ethanol induced gastric ulcer models while using acetic acid induced ulcer model	Flavonoids	(Mayilsamy et al 2013, Kavitha Shree et al 2012)
Clove Syzygium aromaticum L. [Myrtaceae]	Dried flower buds n-butanol extract	200mg/kg; s.c.	Indomethacin-induced gastric ulcer model	Flavonoids, tannins	(Magaji et al 2007)
Costus, Kuth, Kushta Saussurea lappa [Asteraceae]	Root Ethyl acetate extract	400mg/kg; orally	Ethanol, aspirin and by pyloric ligation Induced Ulcer Model	Alkaloids, flavanoids, carbohydrates, glycosides, phenols, gums and mucilage.	(Sutar et al 2011)
Katakam Strychnos potatorum Linn. [Loganiaceae]	Seeds aqueous extract	200mg/kg; orally	Aspirin plus pyloric ligation induced gastric ulcer model	alkaloids, flavonoids, glycosides, phenols, saponins	(Sanmugapriya et al 2007)
Tamarind tree Tamarindus indica [Caesalpiniaceae]	Leaves Methanolic extract	200 mg/kg; orally	Pylorus ligation induced ulcer model	Tannins	(Kumar et al 2011)
Harada Terminalia chebula [Combretaceae]	Fruits Methanolic extract	500 mg/kg; orally	Pylorus ligation and ethanol induced gastric Ulcers Model	Tannins, gallic acid, chebulinic acid, and sorbitol	(Raju et al 2009)
Mucuíba Virola surinamensis (R.) [Myristicaceae]	Bark Ethanol extract	500mg/kg; orally	Indomethacin, stress and pylorus ligature Induced Ulcer Model	Flavonoids, terpenoids	(Hiruma-Lima et al 2001)
Wild Jujube Zizyphus oenoplia (L.) Mill. [Rhamnaceae]	Roots Ethanol extract	300mg/kg; orally	Indomethacin, stress and pylorus ligature Induced Ulcer Model	Alkaloids, saponins, sterols	(Jadhav et al 2011)
Jujube Zizyphus lotus (L.) Lam. Rhamnaceae	Root bark, leaves, Fruits Aqueous extracts	Root bark and leaves: 200 mg/kg; orally Fruits: 400 mg/kg; orally	HCl/ethanol Induced Ulcer Model	Flavonoids, terpenoids	(Wahida et al 2007)
Ginger Zingiber Officinale Roscoe [Zingiberaceae]	Rhizomes Ethanol extracts	200 mg/kg; orally	Acetic acid-induced ulcer Model	Flavonoids, terpenoids, Alkaloids, saponins, sterols	(Rao et al 2010)
Henna tree Lawsonia inermis [Lythraceae]	Leaf Ethanol extract	100, 200 and 400mg/kg; orally	indomethacin- induced gastric ulcer	Flavonoids, terpenoids,	(Macharla et al 2011)
Large Caltrops and Gokhru Pedalium murex [Pedaliaceae]	Fresh juice of leaves	0.5, 1.0, 2.0ml/100gm; orally	ethanol induced gastric ulcer	flavonoids and mucilage	(Singh et al 2009)
Horse gram Macrotyloma uniflorum [Fabaceae]	whole seeds hydro-alcoholic	(150mg/kg) oral route	pyloric ligation and stress induced ulcer model.	alkaloid, carbohydrates, saponin, flavonoids, glycosides, tannins and proteins	(Bose et al 2020)
Bidi leaf tree Bauhinia racemose [Fabaceae]	Leaves Methanolic extract	400mg/kg orally	aspirin or ethanol or indomethacin induced ulcer model	Flavonoids, terpenoids, Tannins, gallic acid	(Bhalke et al 2011)

 

2. CONCLUSION AND RECOMMENDATIONS:

PUD is a common health problem faced by all age groups population and it becomes a cause of mortality in developed as well as developing countries. The commonly used drug therapy for the treatment of PUD is based on the potent synthetic drug regimens which produces adverse effects that might also be a cause of health complications on regular use. Commonly used drugs for PUD are, H₂ antihistamines - ranitidine, famotidine, roxatidine which are potent to cure the PUD but causes adverse effects like, headache, diarrhoea, constipation, dizziness, bowel upset, disorientation and rashes. Moreover, cimetidine, an H₂ antihistamines causes headache, dizziness, bowel upset, dry mouth, rashes; CNS effects like confessional state of mind, restlessness, convulsions and coma in elderly patients; bradycardia, arrhythmias and cardiac arrest, antiandrogenic actions adverse effects (Tripathi 2014, Goodman et al 2011). Other chemotherapy used for PUD is proton pump inhibitors like, omeprazole, lansoprazole, pantoprazole, rabeprazole, esomeprazole which are reported to cause nausea, loose stools, headache, abdominal pain, muscle and joint pain, dizziness, rashes, pro­longed treatment causes atrophic gastritis, etc. as adverse effects. PUD chemotherapy also includes anticholinergics like, pirenzepine, propantheline, oxyphenonium which are reported to cause dry mouth, visual disturbance, and urinary retention as common adverse effects (Tripathi 2014, Goodman et al 2011). Misoprostol, a prostaglandin analogue is reported to cause diarrhoea, abdominal cramps, uterine bleeding, abortion, and need for multiple daily doses. Antacids has been remaining a method for PUD management by neutralization of gastric acid. Sodium bicarbonate is reported to absorbed systemically and large dose induces alkalosis and regular use may have risk of ulcer perforation; other antacids - sodium citrate, magnesium hydroxide, magnesium trisilicate, aluminium hydroxide, magaldrate, calcium carbonate causes constipation, osteomalacia, hypophosphatemia, aluminium-intoxication with aluminium hydroxide etc. as adverse effects. Ulcer protectives - sucralfate cause constipation, hypophosphatemia by binding phosphate ions in the intestine and colloidal bismuth sub citrate are reported to causes diarrhoea, headache, dizziness, and encephalopathy due to bismuth toxicity as common adverse effects. Prolonged use of antacids reported to cause osteodystrophy. Use of antibiotics like amoxicillin, clarithromycin, metronidazole, tinidazole, tetracycline for the treatment of infection due to H. pylori has also been a main drug therapy but repeated use of antibiotics might develop microbial resistance to the antibiotics (Tripathi 2014, Goodman et al 2011).

 

Traditional knowledge of ethno-medicines is based on the practical experiences from generations to generations. Plant drugs remains be a wide source of remedy in earlier days, hence evolved as a big source of drugs. Plants drugs have been a reliable source of treatment of various health problems including PUD. A number of researches has been undergone which claim the experimental evidence of validations of the folklore utilization of medicinal herbs in PUD. Gastric problems are not only affecting the health of human being but also generate a number of health consequences with disturbance of daily life. Although a number of synthetic drug chemotherapy are available for the treatment of PUD. No doubt some of them are very much effective as well but they are reported to have adverse effects also which might be fatal sometimes. A number of plant drugs has been reported their ethnopharmacological and scientific reports which claims their potential role in the therapy of PUD. Some plant extracts were reported to posse’s significant pharmacological action in PUD and have documented evidence for their interventions in the treatment of PUD. A number of plant drugs have reported to have significant pharmacological actions in PUD. Some plants like, Acacia Arabica, Aegle marmelos, Amomum subulatum, Allium sativum, Aloe vera, Annona squamosa, Azadirachta indica, Bahunia variegarta, Berberis aristate, Carica papaya, Cucumber sativus, Cocus nucifera, Ficus religiosa, Glycyrrhiza glabra, etc. which have reported their pharmacological effects in PUD are mentioned in table 1. It is recommended to utilize the medicinal plants as phytotherapy or as adjuvant with the synthetic drugs for better effect and to minimize the adverse effects. 

 

The present review article was planned to highlight the potential medicinal plants effective in PUD which serve a source of information to the medical practitioners, academicians and the researchers working in the related fields.

 

ACKNOWLEDGEMENT:

Authors would like to thank Chandigarh University for providing necessary facilities.

 

DECLARATIONS OF INTEREST:

Authors declare no conflict of interest.

 

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Received on 25.08.2021           Modified on 09.11.2021

Accepted on 29.12.2021         © RJPT All right reserved