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Natural Products in Treatment of Ulcerative Colitis and Peptic Ulcer

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Natural Products in Treatment of Ulcerative Colitis and Peptic Ulcer Journal of Saudi Chemical Society (2013) 17, 101–124 King Saud University Journal of Saudi Chemical Society www.ksu.edu.sa www.sciencedirect.com ORIGINAL ARTICLE Natural products in treatment of ulcerative colitis and peptic ulcer Amani S. Awaad a, Reham M. El-Meligy a,*, Gamal A. Soliman b a Chemistry Department, Faculty of Science, King Saud University, Riyadh, Saudi Arabia b Pharmacology Department, Faculty of Pharmacy, Salman Ibn Abd Al Aziz University, Al-Kharj, Saudi Arabia Received 23 February 2012; accepted 5 March 2012 Available online 15 March 2012 KEYWORDS Abstract Ulcerative colitis is an inflammatory chronic disease that affects the mucosa and submu- Plant extracts; cosa of the colon and rectum. Several types of drugs are available such as aminosalicylates. Peptic Gastroprotective; ulcer disease (PUD) is a common disorder that affects millions of individuals worldwide and it can Flavonoids; be considered one of the most important common diseases in the world. Treatment of peptic ulcers Peptic ulcer; depends on using a number of synthetic drugs that reduce the rate of stomach acid secretion (Anti- Anti-Helicobacter pylori; acids), protect the mucous tissues that line the stomach and upper portion of the small intestine Ulcerative colitis (Demulcents) or to eliminate Helicobacter pylori (H. pylori). In most cases, incidence of relapses and adverse reactions is seen in the following synthetic antiulcer therapy. Accordingly, the main concern of the current article is to introduce a safe drug (or more) of natural origin, to be used for the management of gastric ulcers without side effects. A widespread search has been launched to identify new anti-ulcer therapies from natural sources. Herbs, medicinal plants, spices, vegetables and crude drug substances are considered to be a poten- tial source to control various diseases including gastric ulcer and ulcerative colitis. In the scientific literature, a large number of medicinal plants and their secondary metabolites with potential anti- ulcer (anti-peptic ulcer and antiulcerative colitis) activities have been reported. Treatment with nat- ural products produces promising results and fewer side effects. Our goal is to collect the published * Corresponding author. Address: Chemistry Department, Faculty of Sciences, King Saud University, Al-steen Street, Almalaz, P.O. Box 22452, Riyadh 11495, Saudi Arabia. Tel.: +966 14785447x1412; fax: +966 14772245. E-mail addresses: [email protected], [email protected] (R.M. El-Meligy). 1319-6103 ª 2012 King Saud University. Production and hosting by Elsevier B.V. All rights reserved. Peer review under responsibility of King Saud University. http://dx.doi.org/10.1016/j.jscs.2012.03.002 Production and hosting by Elsevier 102 A.S. Awaad et al. data in the last 24 years and reviews the natural products reported in the treatment of these diseases and their mechanism of action. ª 2012 King Saud University. Production and hosting by Elsevier B.V. All rights reserved. 1. Introduction 2.3. Treatment with synthetic drugs Ulcers in the gastrointestinal tract could be divided into two Currently, there is no an effective therapy to cure the disease common types according to location; ulcerative colitis (lower) but the mainstream treatment depends on reduction of the and peptic ulcer (upper). Ulcerative colitis (UC) is an inflam- abnormal inflammation in the colon lining and thereby relieves matory bowel disease that primarily affects the colonic muco- the symptoms of diarrhea, rectal bleeding, and abdominal sa. In its most limited form it may be restricted to the distal pain. The treatment depends on the severity of the disease; rectum, while in its most extended form, the entire colon is in- therefore treatment is adjusted for each individual (Botoman volved (DiPiro et al., 2002). UC can occur in both sexes and in et al., 1998). Most people with mild or moderate ulcerative any age group but most often begins in people between 15 and colitis are treated with corticosteroids (dexamethasone) to re- 30 years of age. The exact causes of UC are still not clear but duce inflammation and relieve symptoms (Hanauer et al., different factors have been postulated as possible etiologic 2004). Nearly 25% of patients with UC requiring steroids ther- agents. They are genetic factors, infective agents, immunolog- apy become steroid-dependent after one year, and virtually all ical basis, smoking, medications and pathological factors develop steroid-related adverse events (Faubion et al., 2001). (Berardi, 2000). Other drugs as immunomodulators (azathioprine and Peptic ulcer disease (PUD) is an illness that affects a consid- 6-mercapto-purine) that reduce inflammation by affecting the erable number of people worldwide. It develops when there is immune system (Bresci et al., 1997) and aminosalicylates an imbalance between the ‘‘aggressive’’ and ‘‘protective’’ fac- (Rachmilewitz, 1989) are available. tors at the luminal surface of the epithelial cells. Aggressive factors include Helicobacter pylori, HCl, pepsins, nonsteroidal 3. Peptic ulcer anti-inflammatory drugs (NSAIDs), bile acids, ischemia, hy- poxia, smoking and alcohol. While defensive factors include 3.1. Symptoms bicarbonate, mucus layer, mucosal blood flow, PGs and growth factors (Harold et al., 2007). Small ulcers may not cause any symptoms however some big ulcers can cause serious bleeding. Although there are common 2. Ulcerative colitis shared symptoms (Malagelada et al., 2007) which include: 2.1. Symptoms Feeling of fullness, unable to drink as much fluid. Hunger and an empty feeling in the stomach, often 1–3 h In patients with UC, ulcers and inflammation of the inner after a meal. lining of the colon lead to symptoms of bloody diarrhea, Mild nausea (vomiting may relieve symptom). passage of pus, mucus, and abdominal cramping during bo- Pain or discomfort in the upper abdomen. wel movements (Baumgart and Sandborn, 2007). Most pa- Upper abdominal pain that wakes you up at night. tients with UC experience intermittent bouts of illness after varying intervals with no symptoms (DiPiro et al., 2002). In addition to some symptoms in some cases: Clinical signs of the disease may be mild, moderate or severe: Bloody or dark stools Chest pain Mild: Less than four stools per day, with or without blood, Fatigue with no systemic disturbance and a normal erythrocyte sed- Vomiting imentation rate (ESR). Weight loss Moderate: More than four stools per day with minimal sys- temic disturbance. Severe: More than six bloody stools per day, with the evi- 3.2. Diagnosis dence of systemic disturbance as fever, tachycardia, anemia, or ESR of more than 30. The following tests could be done to diagnose peptic ulcer: 1. Esophagogastroduodenoscopy (EGD): in which a thin tube 2.2. Diagnosis with a camera on the end is inserted through the mouth into the GI tract to see the stomach and small intestine. During The diagnosis of UC is made on clinical suspicion and con- an EGD, a biopsy may be taken from the wall of the stom- firmed by biopsy, stool examinations, sigmoidoscopy or ach to test for H. pylori. colonoscopy, or barium radiographic examination. The pres- 2. X-ray for the upper gastrointestinal tract (GIT) which ence of extracolonic manifestations such as arthritis, and taken after drink a thick substance called barium. uveitis may also aid in establishing the diagnosis (DiPiro 3. Hemoglobin blood test to check if there is anemia. et al., 2002). 4. Stool guaiac to test if there is blood in the stool. Natural products in treatment of ulcerative colitis and peptic ulcer 103 3.3. Treatment with synthetic drugs changes in the colon after induction of recurrent colitis, as demonstrated by reduced colonic weight/length ratio and mac- Several classes of pharmacological agents have proved to be roscopic and microscopic damage scores (Wang et al., 2010). effective in the management of the acid peptic disorders. These Another study (Li et al., 2008) confirmed this fact as, GSPE groups include: antacids (aluminum hydroxide, magnesium tri- exerts a beneficial anti-inflammatory effect in the acute phase silicate), acid suppressive agents (Antisecretory drugs) which in- of TNBS-induced colitis in rats by down regulating some of clude proton pump H+/K+ ATPase inhibitors (omeprazole, the mediators involved in the intestinal inflammatory response, lanzoprazole), histamine H2 receptor antagonist (cimetidine, inhibiting inflammatory cell infiltration and antioxidation ranitidine) and anticholinergic (M1) (pirenzepine), cytoprotec- damage, promoting damaged tissue repair to improve colonic tive agents (sucralfate and prostaglandin analogs (misopros- oxidative stress, decreasing production of proinflammatory tol), antimicrobials for eradication of H. pylori (amoxicillin, cytokines interleukin IL-1beta, and increasing production of clarithromycin) and Triple therapy (one week triple therapy anti-inflammatory cytokines IL-2 and IL-4. consisting of a proton pump inhibitor such as Omeprazole Garcinia cambogia Desr. (Clusiaceae) extract has attracted and the antibiotics Clarithromycin and Amoxicillin) (Waller interest due to its pharmacological properties, including gas- et al., 2005; Katzung, 2004). troprotective effects. The anti-inflammatory activity of the A widespread search has been launched to identify new alcohol extract in TNBS-induced colitis rats was investigated. anti-ulcer therapies from natural sources to replace currently The results obtained revealed that garcinia administration to used drugs of doubtful efficacy and safety. Herbs, medicinal
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