Review Article R.Ramasubramaniaraja et al. / Journal of Pharmacy Research 2011,4(1),156-160 ISSN: 0974-6943 Available online through http://jprsolutions.info Peptic Ulcer and Phytochemistry : An Overview *R.Ramasubramaniaraja1 and M Niranjan Babu2 1Lecturer, Department of Pharmacognosy, Seven Hills College of Pharmacy, Tirupathi 2Principal, Seven Hills College of Pharmacy, Tirupathi Received on: 15-09-2010; Revised on: 18-10-2010; Accepted on:13-12-2010 ABSTRACT Peptic ulcer disease is an ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. As many as 70-90% of ulcers are associated with H.pylori a spiral shaped bacterium that lives in the acidic environment of the stomach. Ulcers can also be caused by drugs such as aspirin and other NSAIDS. Naturally occurring the Pytoconstituents like flavanoids, Saponin, tannins gums and mucilage are functioned to cure the peptic ulcer. Phytoconstitents is very cheap with economic and with out side effect produce when compare to allopathic drugs. Phytochemicals produced medicinal herbs also screened. Key words: Peptic ulcer, Flavanoids, phytochemicals, Azadirachtra indica, Tannins. INTRODUCTION3 Ulcer is an open discontinuation on the skin or on mucous membrane it may · Melena (tarry, foul –smelling feces due to oxidized iron from hemo- be shallow or deep. Ulceration occurs when there is a disturbance of the globin) normal equilibrium caused by either enhanced aggression or diminished mu- · Rarely an ulcer can bead to a gastric or duodenal perforation which cosal resistance. (or) It is a excavation of the surface, of an organ or tissue, leads to acute peritonitis. This is extremely painful and requires produced by sloughing of necrotic inflammatory tissue. A peptic ulcer, also immediate surgery. called as ulcerpepticum, PUD or peptic ulcer disease is an ulcer (defined as mucosal erosions equal to or greater than 0.5cm) of an area of the gastrointes- A history of heartburn, gastroesophageal refulx disease (GERD) and use of tinal tract that is usually acidic and thus extremely painful. As many as 70- certain forms of medication can raise the suspicion for peptic ulcer. Medicines 90% of ulcers are associated with H.pylori a spiral shaped bacterium that lives associated with peptic ulcer include NSAID that inhibit cyclooxy genase & in the acidic environment of the stomach, however only 40% of those cases most glucocorticoids. go to a doctor. Ulcers can also be caused or worsened by drugs such as aspirin and other NSAIDS5. (Non Steroidal anti-inflammatory drugs). Contrary to Ex: dexamethasone and prenisolone. In Patients over 45with more that two general belief more peptic ulcers arise in the duodenum (Ist part of the small weeks of the above symptoms that odds for ulceration are high enough to intestine just after the stomach) rather than in the stomach about 4% of warrant rapid investigation by Esophagoggastroduodenoscopy. The timing of stomach ulcers are caused by malignant tumor, so multiple biopsies are needed symptoms in relation to the meal my differentiate between gastric and duode- to exclude cancer. Duodenal ulcers are generally benign. nal ulcers. A gastric ulcer would give epigastria pain during the meal as gastric acid is secreted or after the meal as the alkaline duodenal contents reflux in to Classification3 the stomach. Symptoms of duodenal ulcers would manifest mostly before the · Stomach is called as Gastric ulcer / peptic ulcer meal when acid is passed into the duodenum. However, this is not a reliable · Duodenum is called duodenal ulcer sign in clinical practice. · Oesophagus is called oesophageal ulcer · Meckel’s Diverticulum is called meckel’s Diverticulum ulcer. The symptoms of peptic ulcers may vary with the location of the ulcer and the patients age usually children and the elderly do not develop any symptoms Types of Peptic ulcer3 unless complications have arisen. · TypeI : Ulcer along the lesser curve of stomach · TypeII : Two ulcers present - one gastric, one duodenal Burning or growing feeling in the stomach area lasting between 30minutes and · TypeIII : Prepyloric ulcer 3 hours commonly accompanies ulcers. This pain can be misinterpreted as · TypeIV : Proximal gastro esophageal ulcer hunger, indigestion or hear burn pain is usually caused by the ulcer but it may · TypeV : Anywhere be aggravated by the stomach acid when it comes into contact with the ulcer- ated area. The pain caused by peptic ulcers can be felt anywhere from the Signs and symptoms3,5 navel upto the breast bone it may last from few minutes to several hours and · Symptoms of a peptic ulcer can be it may be worse when the stomach is empty. Also times the pain may flare at Abdominal pain-Classically epigastria with severity relating to meal- nigh and it can commonly be temporatily relived by eating foods that buffer times after around 3 hours of taking a meal stomach acid or by taking anti-acid medication. · Bloating and abdominal fullness · Water brash Cause5 · Nausea, and copious vomiting A major causative factor (60% of gastric and upto 90% od duodenal ulcers) is · Loss of appetite and weight loss chronic inflammation due to H.pylori that colonizes the antral mucosa. The · Hematemesis (Vomiting of blood): This can occur due to bleeding immune system is unable to clear the infection despite the appearance of directly from a gastric ulcer or from damage to the esophagus from antibodies. Thus the bacterium can cause a chronic active gastric resulting in severe / continuing vomiting. a defect in the regulation of gastrin production by that part of the stomach and gtastrin secretion can either be decreased resulting in hypo- or achlorhydria or *Corresponding author. increased Gastrin stimulates the productio9n of gastric acid by parietal cells and in H.pylori cononization responses that increase gastrin, the increases in R.Ramasubramaniaraja acid can contribute to the erosion of the mucosa and therefore ulcerformatrion. M.Pharm., Another major causes is the use of NSAIDS. The gastric mucosa protects itself Lecturer Department of Pharmacognosy, from gastric acid with a layer of mucus, the secretion of which is stimulated by Seven Hills College of Pharmacy certain prostaglandins. NSAIDS block the function of clyclooxygenase1 (cox- Tirupathi,Andhra Pradesh, India 1). This is essential for the production of these prostoglandins Cox-2 selec- Tel.: + 91-9494516207 E-mail:[email protected] Journal of Pharmacy Research Vol.4.Issue 1. January 2011 156-160 R.Ramasubramaniaraja et al. / Journal of Pharmacy Research 2011,4(1),156-160 tive anti-inflammatoryes (such as celecoxib or the since with drawn rofecoxib) 1. Flavonoids preferentially inhibit COX-2 which is less essential in the gastric mucosa and 2. Saponins roughly halve the risk of NSAID-related gastric ulceration. 3. Tannins 4. Gums and mucillages Stress5 Flavonoids Researchers also continue to look at stress as a possible cause, or at least Flavanoids are a group of about 4000 naturally ocurring compounds with wide complication in the development of ulcers. There is debate as to whether range of biological effects, including anti-ulcer activity. They are important psychological stress can influence the development of peptic ulcers. Burns constituents of the human diet and are also found inseveral medicinal plants and head trauma, however can lead physiological stress ulcers which are re- used in folk medicine around the world. Mechanism have been proposed to ported in many partients who are on mechanical ventilation. explain the gastro protective effect of flavonoids these include increase of mucosal prostaglandin content. Decrease of histamine secretion from mast cells by inhibition of histidine decarboxylase and inhibition of H.pylori growth. Been found to be free radical scavenges free radical play an important role in ulcerative and erosive lesions of the gastrointestinal tract. Flavonoids could have a therapeutic potential ideal for treatment of gastrointestinal disease associated with H.pylori infection. Saponins Saponins are widely distributed in plants and are a particular form of glyco- sides. They are so –called because of their soap –like effect. This is due to their surfactant properties. According to the structure of the aglycone or sapogenins two kinds of saponin are recornized the steroidal and triterpenoid type with regard to plants with anti ulcer activity liquorice root contains about 2% - 12% of glycyrrhizic acid and the seeds of the horse chest nut up to 13% 4 Diagnosis -Endoscope image of gastric ulcer of aescin. Some oleanolic acid oligoglycosides extracted from p.japonicus and - Biopsy proven to be gastric cancer K.scoparia showed protective effects on ethanol and indomethacin induced gastric damage. The protective activities of all these active spaonins are not The diagnosis is mainly established based on the characteristic symptoms. due to inhibition of gastric acid secrtion but probably due to activation of The stomach pain is usually the first to signal a peptic ulcer. In some causes mucous membrane protective facors. doctors may treat ulcers without diagnosing them with specific tests and observe if the symptoms resolve, meaning their primary diagnosis was accu- Botanical name Part plant rate. Calendula officinalis Rhizome Calliandra portoticensis Leaves Confirming the diagnosis is made with the help of test such as 1. Endoscopies Glycyrrhiza glabra Root 2. Barium contrast x-rays. The tests are typically ordered if the symptoms do Kochia scoparia Fruit not resolve after a few weeks of treatment or when they first appear ion a person who is over age 45 or who has other symptoms such as weight loss Tannins: because stomach cancer can cause similar symptoms also, when severe ulcer Tannins are used in medicine primarily because of their astringent properties resist treatment particularly if a person has several ulcers or the ulcers are in which are due to the fact that they react with the proteins of the layers of unusual place a doctor may suspect an underlying condition that causes the tissue with which they come into contact.