Review Article ISSN 2277-3657 Available online at www.ijpras.com International Journal of Volume 2, issue 2 (2013),9-23 Pharmaceutical Research & Allied Sciences Herbs Used In Peptic Ulcer: A Review Saumendu Deb Roy 1* , Jashabir Chakraborty 2, Dibyendu Shil 1, Sumit Das 3, Narzima Begum 2. 1. Deptt. Of Pharmacognosy, Girijananda Chowdhury Institute of Pharmaceutical Science, Guwahati, Assam. 2. Deptt. Of Pharmacology, Girijananda Chowdhury Institute of Pharmaceutical Science, Guwahati, Assam. 3. Deptt. Of Pharmaceutical Chemistry, Girijananda Chowdhury Institute of Pharmaceutical Science, Guwahati, Assam. E-mail: [email protected] Subject: Pharmacognosy Abstract Peptic ulcer, also known as PUD or peptic ulcer disease, is an ulcer (defined as mucosal erosions equal to or greater than 0.5 cm) of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. 1 Symptoms include abdominal pain with severity relating to mealtimes, after around 3 hours of taking a meal; bloating and abdominal fullness; nausea, and copious vomiting; loss of appetite and weight loss etc. 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. And the present study was aimed to collect information on various herbs which are used in treating Peptic Ulcer in various parts of the world, depending upon the data’s provided by various researchers. Key Words: Peptic Ulcer, Helicobacter pylori, Gastrin, Herbs. Introduction Peptic ulcer, also known as PUD or peptic ulcer This is extremely painful and requires immediate disease, is an ulcer (defined as mucosal erosions surgery. A history of heartburn, gastroesophageal equal to or greater than 0.5 cm) of an area of the reflux disease (GERD) and use of certain forms of gastrointestinal tract that is usually acidic and thus medication can raise the suspicion for peptic ulcer. extremely painful. 1 Symptoms includes abdominal Medicines associated with peptic ulcer include pain, classically epigastric with severity relating to NSAID (non-steroid anti-inflammatory drugs) that mealtimes, after around 3 hours of taking a meal inhibit cyclooxygenase, and most glucocorticoids (duodenal ulcers are classically relieved by food, (e.g. dexamethasone and prednisolone). while gastric ulcers are exacerbated by it); bloating and abdominal fullness; waterbrash (rush of saliva In patients over 45 with more than two after an episode of regurgitation to dilute the acid in weeks of the above symptoms, the odds for peptic esophagus); nausea, and copious vomiting; loss of ulceration are high enough to warrant rapid 2,3 appetite and weight loss; hematemesis (vomiting of investigation by EGD The timing of the symptoms blood); this can occur due to bleeding directly from a in relation to the meal may differentiate between gastric ulcer, or from damage to the esophagus from gastric and duodenal ulcers: A gastric ulcer would severe/continuing vomiting; melena (tarry, foul- give epigastric pain during the meal, as gastric acid smelling feces due to oxidized iron from production is increased as food enters the stomach. hemoglobin). Symptoms of duodenal ulcers would initially be relieved by a meal, as the pyloric sphincter closes to Rarely, an ulcer can lead to a gastric or concentrate the stomach contents, therefore acid is duodenal perforation, which leads to acute peritonitis. not reaching the duodenum. Duodenal ulcer pain 9 Available online at www.ijpras.com would manifest mostly 2-3 hours after the meal, NSAIDs: Another major cause is the use of when the stomach begins to release digested food and NSAIDs (see above). The gastric mucosa protects acid into the duodenum. Also, the symptoms of itself from gastric acid with a layer of mucus, the peptic ulcers may vary with the location of the ulcer secretion of which is stimulated by certain and the patient's age. Furthermore, typical ulcers tend prostaglandins. NSAIDs block the function of to heal and recur and as a result the pain may occur cyclooxygenase 1 (cox-1), which is essential for the for few days and weeks and then wane or disappear. production of these prostaglandins. COX-2 selective Usually, children and the elderly do not develop any anti-inflammatories (such as celecoxib or the since symptoms unless complications have arisen. withdrawn rofecoxib) preferentially inhibit cox-2, which is less essential in the gastric mucosa, and Complications :4,5 roughly halve the risk of NSAID-related gastric ulceration. As the prevalence of H. pylori-caused Gastrointestinal bleeding is the most common ulceration declines in the Western world due to complication. Sudden large bleeding can be life- increased medical treatment, a greater proportion of threatening. It occurs when the ulcer erodes one of ulcers will be due to increasing NSAID use among the blood vessels, such as the gastroduodenal artery. individuals with pain syndromes as well as the Perforation (a hole in the wall) often leads to growth of aging populations that develop arthritis. catastrophic consequences. Erosion of the gastro- intestinal wall by the ulcer leads to spillage of The incidence of duodenal ulcers has stomach or intestinal content into the abdominal dropped significantly during the last 30 years, while cavity. Perforation at the anterior surface of the the incidence of gastric ulcers has shown a small stomach leads to acute peritonitis, initially chemical increase, mainly caused by the widespread use of and later bacterial peritonitis. The first sign is often NSAIDs. The drop in incidence is considered to be a sudden intense abdominal pain. Posterior wall cohort-phenomenon independent of the progress in perforation leads to pancreatitis; pain in this situation treatment of the disease. The cohort-phenomenon is often radiates to the back. probably explained by improved standards of living which has lowered the incidence of H. pylori Penetration is when the ulcer continues into infections adjacent organs such as the liver and pancreas. Scarring and swelling due to ulcers causes narrowing Stress: Researchers also continue to look at stress as a in the duodenum and gastric outlet obstruction. possible cause, or at least complication, in the Patient often presents with severe vomiting. Cancer is development of ulcers. There is debate as to whether included in the differential diagnosis (elucidated by psychological stress can influence the development biopsy), Helicobacter pylori as the etiological factor of peptic ulcers. Burns and head trauma, however, making it 3 to 6 times more likely to develop can lead to physiologic stress ulcers, which are stomach cancer from the ulcer. reported in many patients who are on mechanical ventilation. Cause of Peptic Ulcer An expert panel convened by the Academy of Helicobacter pylori: A major causative factor (60% Behavioral Medicine Research concluded that ulcers of gastric and up to 90% of duodenal ulcers) is are not purely an infectious disease and that chronic inflammation due to Helicobacter pylori that psychological factors do play a significant colonizes the antral mucosa. The immune system is role.Researchers are examining how stress might unable to clear the infection, despite the appearance promote H. pylori infection. For example, of antibodies. Thus, the bacterium can cause a Helicobacter pylori thrives in an acidic environment, chronic active gastritis (type B gastritis), resulting in and stress has been demonstrated to cause the a defect in the regulation of gastrin production by that production of excess stomach acid. This was part of the stomach, and gastrin secretion can either supported by a study on mice showing that both long- be decreased (most cases) resulting in hypo- or term water-immersion-restraint stress and H. pylori achlorhydria or increased. Gastrin stimulates the infection were independently associated with the production of gastric acid by parietal cells and, in H. development of peptic ulcers. pylori colonization responses that increase gastrin, the increase in acid can contribute to the erosion of A study of peptic ulcer patients in a Thai hospital the mucosa and therefore ulcer formation. showed that chronic stress was strongly associated with an increased risk of peptic ulcer, and a 10 Available online at www.ijpras.com combination of chronic stress and irregular mealtimes Some medicinal plants used in the treatment of ulcer: was a significant risk factor. Ficus arnottiana , Gymnosporia motana Gastrinomas (Zollinger Ellison syndrome): it is a rare gastrin-secreting tumors, also cause multiple and Alstonia Scholari Azadirachta indica, difficult to heal ulcers. Asparagus racemosus, Berberis asiatica Smoking: Studies show that cigarette smoking can increase a person's chance of getting an ulcer. Bauhinia variegata Aloe vera Smoking also slows the healing of existing ulcers and contributes to ulcer recurrence. Butea frondosa, Hibiscus rosa sinensis, Caffeine : Beverages and foods that contain caffeine Carica papaya Astragalus membranaceus, can stimulate acid secretion in the stomach. This can Annona squamoza, Rheum emodi, aggravate an existing ulcer, but the stimulation of stomach acid can't be attributed solely to caffeine. Benincasa hispida Curcuma longa Alcohol : While a link hasn't been found between Eruca sativa, Uncaria tomentosa, alcohol consumption and peptic ulcers, ulcers are more common in people who have cirrhosis of the