INTRODUCTION:

Peptic ulcer disease is an imbalance of aggressive gastric luminal factors like acid and pepsin and defensive mucosal barrier function may be environmental and host factors contribute to ulcer formation by increasing gastric acid secretion or weakening the mucosal barrier.⁽^1,2)The gastric mucosa is continuously exposed to potentially injurious agents such as acid, pepsin, bile acids, food ingredients, bacterial products (Helicobacter pylori) and drugs. These agents have been implicated in the pathogenesis of gastric ulcer, including enhanced gastric acid and pepsin secretion, inhibition of prostaglandin synthesis and cell proliferation growth, diminished gastric blood flow and gastric motility. In India, PUD is common. In the Indian Pharmaceutical industry, antacids and antiulcer drugs share 6.2 billion rupees and occupy 4.3% of the market share. Recently, there has been a rapid progress in the understanding of the pathogenesis of peptic ulcer. Most of the studies focus on newer and better drug therapy. Several plant species like Allophylus serratus Ocimum sanctum, Aemblica officinalis, Convovulus pluricaulis, and Aspagus racemosus has shown encouraging findings.⁽^3,4)

Peptic ulcer:

Peptic ulcer disease is an imbalance between offensive and defensive gastric factors. A peptic ulcer is a sore in the lining of your stomach or duodenum. The duodenum is the first part of your small intestine. If peptic ulcers are found in the stomach, they’re called gastric ulcers. If they’re found in the duodenum, they’re called duodenal ulcers. According to the American College of Gastroenterology, about 20 million Americans will develop an ulcer during their life.^(5,6)Contrary to popular belief; ulcers are not caused by spicy food or stress.^(5,6,7)Instead, a type of bacteria called Helicobacter pylori is usually to blame. Long term use of non steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil), can also case ulcers. A burning pain in the gut is the most common symptom. The pain feels like a dull ache comes and goes for a few days or weeks starts 2 to 3 hours after a meal comes in the middle of the night when your stomach is empty usually goes away after you eat. Other symptoms are losing weight, not feeling like eating, having pain while eating, feeling sick to your stomach, vomiting. Some people with peptic ulcers have mild symptoms. Neither stress nor spicy foods cause ulcers. But they can make ulcers worse. Drinking alcohol or smoking can make ulcers worse, too. Peptic ulcers will get worse if they aren’t treated.^(8,9,10)

Plants used to treat peptic ulcer:-

There are many herbs, nutrients, and plant products that have been found to play a role in protecting or helping to heal stomach and peptic ulcers. Few human trials are available, but many have show good potential in animal or in vitro studies. A variety of botanical products have been reported to possess antiulcer activity but the documented literature has centred primarily on pharmacological action in experimental animals.⁽¹¹⁾

Except for a few photogenic compounds (i.e. aloe, liquorice and chilly), limited clinical data are available to support the use of herbs as gastro-protective agents and thus, the data on efficacy and safety are limited. Despite this, there are several botanical products with potential therapeutic applications because of their high efficacy and low toxicity. Finally, it should be noted that substances such as Flavonoids, aescin, aloe gel and many others, that possess antiulcer activity are of particular therapeutic importance as most of the anti-inflammatory drugs used in modern medicine are ulcerogenic. Active principles of antiulcer activity are Flavonoids, terpenoids and tannin. Herbal medicines are considered as better alternatives for the treatment of peptic ulcer. ^(12-14)For example, proton pump inhibitors (omeprazole, lansoprazole) may cause nausea, abdominal pain, constipation, diarrhoea and H2 receptor antagonists (cimetidine) may cause gynaecomastia, loss of libido. Due to the occurrence of many side effects by use of synthetic drugs for many diseases, medicinal plants are considered as the main source of new drugs as they have less or no side effects. As herbal medicines are considered as safe for the treatment of ulcers with lesser adverse effects, economical, effective, relatively less toxic, extensive research is carried out in search for potent antiulcer agents of plant origin. This article reviews the features of some of the plants reported to possess antiulcer and ulcer healing properties.^(15-17)

Carica papaya

Local name: Papita.

Family: Caricaceae.

Papaya is a fast-growing, semi-woody tropical herb. The stem is single, straight and hollow and contains prominent leaf scars. Papaya exhibits strong apical dominance rarely branching unless the apical meristem is removed or damaged. The fruit is oval to nearly round, somewhat pyriform, or elongated club-shaped, the skin of papaya is waxy and thin but fairly tough. When the fruit is immature, it is rich in white latex and the skin is green and hard. As ripening progresses the papaya fruit develops to a light- or deep-yellow-orange coloured skin while the thick wall of succulent flesh becomes aromatic, yellow orange or various shades of red. When papaya becomes fully ripped it is then juicy, sweetish and somewhat like a cantaloupe in flavour but some types is quite musky. Mature fruits contain numerous grey-black ovoid seeds attached lightly to the tannin. Papaya is used in tropical folk medicine. Papaya latex is very much useful for curing dyspepsia and is externally applied to burns and scalds. The fruit and its seeds have anthelmintic and antiamebic activities. It contains many biologically active compounds. Two important compounds are chymopapain and papain, which are widely known as being useful for digestive disorders and disturbances of the gastrointestinal tract. Main chemical components are papain, chymopapain, pectin, carposide, carpaine, pseudocarpaine, dehydrocarpines, carotenoids, crypto glavine, cis-violaxanthin and antheraxanthin. It regulates the expression of replicase polyproteins. It is a strong digestive enzyme and useful in serious digestive disorders such as bloating and chronic indigestion. Unique ability of Papain is to break down protein and convert a portion of it into arginine because arginine influences the production of the human growth hormone. It possesses potent spermicidal activity. Papaya is basically an agent that helps in the digestive process. The leaves of the tree as well as the fruit, both ripe and raw, are used medicinally to aid digestion. It is interesting to note the unripe papaya fruit is medicinally more advantageous. The milky white sap produced by the trunk of the papaya tree is also a useful remedy and is applied externally to accelerate the curing of abrasions, ulcers, boils, warts and cancerous growth. The papaya seeds are also useful as when ingested they help in throwing out worms from the body. The latex or the white sap produced by the papaya tree trunk is also effectual in this manner, but comparatively more aggressive. On the other hand, an infusion prepared with the flowers of the plant may be used to stimulate menstruation. The decoction prepared by boiling the ripe fruit in water is useful for curing enduring diarrhea and dysentery among children. While the raw papaya contains a white milky substance called papain, the ripe fruit is moderately laxative and helps in the movement of bowels. The leaves of the papaya tree are useful too as they are often used for dressing wounds and injuries.^(18-23)

Butea frondosa Roxb

Local name: Palaas

Family: Fabaceae

It is a species of Butea, native to tropical southern Asia, from Pakistan, India, Bangladesh, Nepal, Sri Lanka, Myanmar, Thailand and western Indonesia. It is a medium-sized growing to 15 m tall. The leaves are pinnate, with an 8–16 cm petiole and three leaflets, each leaflet 10–20 cm long. The flowers are 2.5 cm long, bright orange-red and produced in racemes up to 15 cm long. The fruit is a pod 15–20 cm long and 4–5 cm broad. It is used for timber, resin, fodder, medicine and dye. The gum from the tree is used in certain food dishes. The wood is dirty white and soft and, being durable under water, is used for well-curbs and water scoops. Good charcoal can be made from it. The main constituent of the flower is butrin (1.5%) besides butein (0.37%) and butin (0.04%). It also contains flavonoids and steroids. Later studies proves that isobutrin slowly change to butrin on drying. Other than these in flowers, coreopsis, isocoreopsin, sulfuring (glycoside) and other two with monospermoside and isomonospermoside structures are also identified. Roots contain glucose, glycine, glucoside and aromatic compounds. Tetramers of leucocyanidin are isolated from gum and stem bark. Seed contains oil. The bright color of the flower is attributed to the presence of chakones and aurones. The fresh juice is applied to ulcers and for congested and septic sore throats. The gum is a powerful astringent given internally for diarrhea and dysentery, phthisis and hemorrhage from stomach and the bladder, in leucorrhea, ringworm and as a substitute for gum Kino. The bark is reported to possess astringent bitter, pungent, alliterative, aphrodisiac and anthelmintic properties. Useful in tumors, bleeding piles and ulcers. The decoction is useful in cold, cough, fever and menstrual disorders. Roots are useful in elephantiasis and in curing night blindness and other eyesight defects. Also cause temporary sterility in women. Also applied in sprue, piles, ulcers, tumors and dropsy. Leaves have astringent, tonic, diuretic and aphrodisiac properties. They are also used to cure boils, pimples and tumors hemorrhoids and piles. Also used as beedi wrappers. Flowers are reported to possess astringent, diuretic, depurative, aphrodisiac and tonic properties. They are used as emmenagogue and to reduce swellings. Also effective in leprosy, leucorrhoea and gout.^(24-26)

Allium sativum

Local name- lahsun

Family-liliaceae

Description- Garlic has historically been grown for both culinary and medicinal purposes. Bulbs are most commonly used, but leaves, scapes, and bulbils are also eaten. Garlic is frequent in the cuisines of Asia, the Middle East, the Mediterranean, and South and Central America. The Common Garlic a member of the same group of plants as the Onion is of such antiquity as a cultivated plant, that it is difficult with any certainty to trace the country of its origin. De Candolle, in his treatise on the Origin of Cultivated Plants, considered that it was apparently indigenous to the southwest of Siberia, whence it spread to southern Europe, where it has become naturalized, and is said to be found wild in Sicily. It is widely cultivated in the Latin countries bordering on the Mediterranean. Dumas have described the air of Provence as being 'particularly perfumed by the refined essence of this mystically attractive bulb.' It has traditionally been used to treat pulmonary problems, coughs, and tuberculosis. Recent works describe numerous traditional medicinal and ritual uses and literary depictions, including the Central European practice of using garlic to fend off evil spirits and vampires. Garlic produces various sulfur compounds that, together with their breakdown products, yield a characteristic pungent taste and odor, which may persist on the breath and body for up to 30 hours as garlic is metabolized. These compounds have documented antimicrobial and antifungal effects. Allicin, derived from garlic, combats fungal infections and parasites, lowers blood cholesterol, treats arterosclerosis, and promotes circulatory function. Garlic preparations are used to treat insect stings and improve scar healing. Epidemiological studies suggest that dietary garlic consumption lowers the risk of various cancers. Diaphoretic, diuretic, expectorant, stimulant many marvellous effects and healing powers have been ascribed to Garlic. It possesses stimulant and stomachic properties in addition to its other virtues. As an antiseptic, its use has long been recognized. In the late war it was widely employed in the control of suppuration in wounds. The raw juice is expressed, diluted with water, and put on swabs of sterilized Sphagnum moss, which are applied to the wound. Where this treatment has been given, it has been proved that there have been no septic results, and the lives of thousands of men have been saved by its use. ^(27-33)It is sometimes externally applied in ointments and lotions, and as an antiseptic, to disperse hard swellings, also pounded and employed as a poultice for scrofulous sores. It is said to prevent anthrax in cattle, being largely used for the purpose.

Momordica charantia

Local name- bitter gourd, Karela.

Family- Cucurbitaceae.

Description- Momordica charantia (Cucurbitaceae) is commonly known as “bitter gourd.” It is locally called as “pavakka-chedi.” This climbing plant is cultivated in gardens everywhere in India, for its fruit. Chemical constituents in this plant are bitter glucoside soluble in water and insoluble in ether, a yellow acid, resin, and ash 6%. Fresh vegetable contains 88.75% moisture, albuminoids 1.62%, soluble carbohydrates 85.41%, woody fiber 1.51%, and ash 8.53%. In Ayurvedic, Whole plant powdered is used for dusting over leprous and other intractable ulcers and in healing wounds; when mixed with cinnamon, long pepper, rice, and chaulmugra oil it forms a good ointment in malignant ulcers. In Recent Studies, Alcoholic and aqueous extract of M. charantia fruit at the doses of 200 and 400 mg/kg separately are used against pylorus ligation, aspirin, and stress induced ulcer in rats. These extracts showed significant reduction in ulcer index as compared to control. The mature fruits of Momordica charantia L. (Cucurbitaceae) are used externally for the rapid healing of wounds and internally for the treatment of peptic ulcers in Turkish folk medicine. For the evaluation of the latter activity, ethanol-induced ulcerogenesis model in rats was employed. The olive oil extract of the material as well as dried-powdered fruits in filtered honey showed significant and dose-dependent anti-ulcerogenic activity against this model. ^(34-39)A potent and dose-dependent inhibitory activity was also observed by the administration of ethanol extract of the fruits. For the bioassay-guided fractionation, the material was first extracted with hexane and then by ethanol and both extracts was found active against the same ulcer model. Furthermore, ethanol extract of the fruits showed significant activity against HCl–EtOH induced ulcerogenesis in indomethacin-pretreated rats and diethyldithiocarbamate-induced ulcer models. Active Constituents Flavonoids, saponins, and sterols are considered.⁽⁴⁰⁾

Aloe vera

Local name- Ghritkumari.

Family- liliaceae

Description- Aloe vera is a stemless or very short-stemmed succulent plant growing to 60–100 cm (24–39 in) tall, spreading by offsets. The leaves are thick and fleshy, green to grey-green, with some varieties showing white flecks on their upper and lower stem surfaces. The margin of the leaf is serrated and has small white teeth. The flowers are produced in summer on a spike up to 90 cm (35 in) tall, each flower being pendulous, with a yellow tubular corolla 2–3 cm (0.8–1.2 in) long. Like other Aloe species, Aloe vera forms arbuscular mycorrhiza a symbiosis that allows the plant better access to mineral nutrients in soil.^(41-44)Aloe vera leaves contain phytochemicals under study for possible bioactivity, such as acetylated mannans, polymannans, anthraquinone C-glycosides, anthrons, anthraquinones, such as emodim, and various Lectins.The natural range of A. vera is unclear, as the species has been widely cultivated throughout the world. Naturalised stands of the species occur in the southern half of the Arabian Peninsula, through North Africa (Morocco, Mauritania, Egypt), as well as Sudan and neighbouring countries, along with the Canary, Cape Verde, and Madeira Islands. In Ayurvedic, Leaves are being used successfully in America in the local treatment of chronic ulcers. First the pain diminishes and after a few weeks the ulcers heal. In Recent Studies, Aloe vera powder was mixed with gum acacia; the solution was administered orally in rats at dose of 200 mg/kg against indomethacin induced gastric ulcer.^(45-48)The extract showed significant antiulcer activity comparable to control. Reported constituents in plant are Amino acids, anthraquinones, enzymes, hormones, lignin, minerals, Salicylic acid, saponins, sterols, sugars, vitamins. The anti-ulcer activity of the plant is reported in Indomethacin induced ulcer model. The mechanism involved in production of antiulcer activity of the plant is due to its antioxidant, anti-inflammatory, mucus secreting, cytoprotective or healing activities. Reported pharmacological activities of the plant are hypoglycaemic, hypolipidemic, wound healing, imunomodulatory, antifungal, hepatoprotective. Active Constituents are Barbalin, isobarbolin, and saponins are considered. ^(49-53)

RESULT:

According to the old hypothesis, acid secretion was thought to be the sole cause of ulcer formation and reduction in acid secretion was thought to be the major approach towards therapy. However, in the light of recent evidences this concept has changed. Now, treatment of ulcer mainly targets the potentiation of the defensive system along with lowering of acid secretion. Chemical substances derived from plants have been used to treat human diseases since the dawn of medicine. Roughly 50% of new chemical entities introduced during the past two decades are from natural products. Recent technological advances have renewed interest in natural products in drug discovery. Therefore, efforts should be directed towards isolation and characterisation of the active principles and elucidation of the relationship between structure and activity. Furthermore, detailed analysis of the active constituents of natural drugs should be directed towards clinical relevance. Standardisation is indispensable to maintain reproducible quality in biological evaluation. Although the clinical efficacy of these preparations is reported by traditional practices, they have not been scientifically validated. Ayurveda, the oldest medicinal system in the world, provides leads to find therapeutically useful compounds from plants. Therefore, ayurvedic knowledge supported by modern science is necessary to isolate, characterise, and standardise the active constituents from herbal source. This combination of traditional and modern knowledge can produce better antiulcer drugs with fewer side effects. Herbs are widely available in India and other countries. The wide spectrum makes them attractive candidates for further research.

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Received on 06.12.2014 Accepted on 11.01.2015

Asian J. Pharm. Tech. 2015; Vol. 5: Issue 1, Pg 32-37

DOI: 10.5958/2231-5713.2015.00007.0