Peptic Ulcers
CHAPTER TWO
LITERATURE REVIEW
2.0 Literature Review
This section presents the isolation and identification of anti-ulcer agents from the extracts of selected medicinal plants in line to the study objectives;
2.1.1 Prevalence
The lifetime risk for developing a peptic ulcer is approximately 10% (Hein et al, 2017), Globally, as of 2010, approximately 250,000 people died of peptic ulcer disease down from 320,000 in 1990 (Rickard, 2022)., while by 2020 Peptic ulcer disease (PUD) affected more than four million people worldwide annually and has an estimated lifetime prevalence of 5−10% in the general population (Kang et al, 2011) In Western countries the prevalence of Helicobacter pylori infections roughly matches age (i.e., 20% at age 20, 30% at age 30, 80% at age 80) (Kamada et al., 2021), Prevalence is higher in third world countries where it is estimated at about 70% of the population, whereas developed countries show a maximum of 40% ratio, PUD deaths are extremely high in these countries; Cambodia, 20.80%, Kiribati, 20.71%, Lesotho, 18.88%, Laos, 16.83% and Central African Republic 15.30% (Slemrod, 2019).
Global burden and demographic profiles of PUD is approximately 8.09 million (95% UI 6.79 to 9.58 million) prevalent cases of PUD in 2019 (Azhari et al., 2018), which represents an increase of 25.82% from 1990 [6.43 million (95% UI 5.41 to 7.63 million) (Lanas, & Chan, 2017), Moreover, the age-standardized prevalence rate in 2019 was 99.40 per 100,000 (95% UI 83.86 to 117.55 per 100,000) population, which represented a decrease from 1990 [143.37 per 100,000 (95% UI 120.54 to 170.25 per 100,000) (Kavitt, et al., 2019).
Between 1990 and 2019, the number of incident cases of PUD increased from 2.82 million (95% UI 2.36 to 3.30 million) to more than 3.59 million (95% UI 3.03 to 4.22), representing an increase of 27.3% in the global incident cases of PUD (Ren et al., 2022), However, the global age-standardized incidence rate of PUD showed a decreasing trend, at 63.84 (95% UI 54.09 to 75.54) per 100,000 populations in 1990 and 44.26 (95% UI 37.32 to 51.87) per 100,000 populations in 2019 (Azhari et al., 2022).
Infections with H. pylori are declining overall, especially in wealthy nations. Peptic ulcer disease is spread through food, contaminated groundwater, and human saliva (through kissing or sharing eating utensils) (Wu et al., 2021), Until the final few decades of the 20th century, when epidemiological patterns started to hint to an astonishing decline in its incidence (Botija, 2021), The identification of the condition’s source, H. pylori, and the introduction of new, efficient medications and acid suppressants are credited with the decline in peptic ulcer disease rates (Gralnek et al., 2021), Over 4 million Americans currently have active peptic ulcers, and 350,000 new cases are identified yearly (Xie et al., 2022).
Peptic ulcers are a common condition worldwide, including in Germany. According to the German Society for Digestive and Metabolic Diseases (DGVS), approximately 5% to 10% of the German population will develop a peptic ulcer at some point in their lives (Loffroy et al., 2021), The prevalence of peptic ulcers in Germany has decreased significantly over the past few decades, thanks in part to improved diagnosis and treatment (Ciubotaru, & Leferman, 2021), This decrease is primarily due to a reduction in Helicobacter pylori infection rates, which is the most common cause of peptic ulcers (Botija et al., 2021), the use of proton pump inhibitors (PPIs) has also played a role in reducing the incidence of peptic ulcers. A 2014 study published in the journal Digestion reported a prevalence of 0.75% for peptic ulcers among 33,514 participants in Germany (Okoye, 2021), the study found that peptic ulcers were more common in older individuals and in those with a history of smoking, heavy alcohol consumption, or regular use of NSAIDs (Azhari et al., 2018).
The literature on the epidemiology of PUD shows that PUD remains a relatively common condition worldwide, with annual incidence ranging from 0.10% to 0.19% for physician-diagnosed PUD and from 0.03% to 0.17% for PUD diagnosed during hospitalization. The 1-year prevalence of physician diagnosed PUD was 0.12–1.5%, and the 1-year prevalence of PUD diagnosed during hospitalizations was 0.10–0.19% (Salari et al., 2022).
Peptic ulcer disease (PUD) is a common condition worldwide. According to the World Gastroenterology Organization, the global prevalence of peptic ulcer disease is estimated to be around 10% to 15% of the population (Kamada et al., 2021), However, the prevalence of peptic ulcer disease varies by region and country, with higher rates reported in developing countries (Ren et al., 2022). The risk factors for peptic ulcer disease include infection with Helicobacter pylori (H. pylori), long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), smoking, alcohol consumption, and stress, The symptoms of peptic ulcer disease include abdominal pain, bloating, nausea, vomiting, and loss of appetite (Azhari et al., 2022).
The treatment of peptic ulcer disease typically involves a combination of medication to reduce stomach acid production and antibiotics to eliminate H. pylori infection (if present) (Chan, 2021), In some cases, surgery may be necessary Lanas, & Chan, (2017), It is important to note that peptic ulcer disease can lead to serious complications, such as bleeding, perforation, and obstruction of the digestive system, which require urgent medical attention (Guo et al., 2021).
The overall prevalence of PUD observed in this study was 4.1%; 19.5% of all PUD cases identified were asymptomatic. Comparing this prevalence with the lower rates obtained from other studies of physician-diagnosed PUD in primary care suggests that a proportion of individuals with PUD remain undiagnosed (Dadfar, & Edna, 2020), In individuals with asymptomatic PUD, severe complications, such as gastrointestinal hemorrhage, may be the first signs of the disease (Malfertheiner & Schulz, 2020), Hemorrhage is associated with mortality approaching 10% and high recurrence, this is particularly relevant for elderly patients who are less likely to have symptoms, possibly because of the analgesic effects of ASA and NSAIDs (Salari et al., 2022).
Peptic ulcers are open sores that develop on the inside lining of the stomach (gastric ulcers) or the upper part of the small intestine (duodenal ulcers). They can be caused by a number of factors, including infection with the bacterium Helicobacter pylori, prolonged use of nonsteroidal anti-inflammatory drugs (NSAIDs), and smoking (Ren et al., 2022).
Peptic ulcers are a common condition worldwide, with an estimated 10% of the global population affected at some point in their lives (Keikha, Ali-Hassanzadeh, & Karbalaei, 2020), The prevalence of peptic ulcers varies depending on the region and population studied, In general, peptic ulcers are more common in developing countries, particularly in areas with low socioeconomic status, poor sanitation, and high rates of Helicobacter pylori infection (Le et al., 2022).
Some studies suggest that the prevalence of peptic ulcers in African countries like Ghana is relatively high, with one study reporting an overall prevalence of 19.5% among patients undergoing upper gastrointestinal endoscopy. However, the prevalence may vary depending on the population studied, and more research is needed to determine the true prevalence of peptic ulcers in Ghana (Sung et al., 2009), The prevalence of peptic ulcers in Nigeria is not well documented, and the available data is limited. However, peptic ulcers are a common gastrointestinal disorder worldwide and are estimated to affect about 4% of the population in developing countries like Nigeria (Zibima et al., 2020), A study conducted in 2018 in Nigeria reported a prevalence of 16.7% of peptic ulcer disease in patients attending a tertiary hospital in Northern Nigeria. Another study conducted in the same year in a different region of Nigeria reported a prevalence of 5.5% (Kayode et al., 2019).
Overall, while the available data on peptic ulcer prevalence in Nigeria is limited, it suggests that peptic ulcers are a significant health problem in the country, and further research is needed to determine their true prevalence and to develop effective prevention and treatment strategies, In Ibadan, Southern Nigeria, DU incidence was 2.3% relative to GU 9.3%, while Northern Nigeria had higher DU incidence 6.8% but lower GU incidence 2.7%. On the contrary, two separate tertiary health centres in Kenya, Nakuru and Nairobi, had similar DU incidence but different GU incidence (Nairobi: GU 8.5%, DU 9.8%; Nakuru: GU 1.9% DU 9.5% (Akinwumi, & Sonibare, 2019).
A decrease in hospital admission from PUD was caused by the availability of efficient medical treatment to eradicate H. pylori as well as trends in the use of over-the-counter H2 antagonists, proton pump inhibitors, and improved cleanliness (Teshome et al., 2019), The blood group O, smoking, and non-steroidal anti-inflammatory medicines are additional risk factors for PUD (Wu et al., 2020), Epigastric pain associated with meals, gastroesophageal reflux, dyspepsia, and melena may be clinical signs of peptic ulcer. Perforation, gastrointestinal obstruction, and malignant transformation are other consequences in addition to gastrointestinal bleeding (Sisay Zewdu, & Jemere Aragaw, 2020).
Peptic ulcer disease (PUD) affects four million people worldwide annually, and has an estimated lifetime prevalence of 5−10% in the general population (Malfertheiner, & Schulz, 2020), Although the global prevalence of PUD has dramatically decreased in the past decades the incidence of its complications has remained constant (Dadfar, & Edna, 2020).
Worldwide, there are significant heterogeneities in coping approaches of healthcare systems with PUD in terms of prevention, diagnosis, treatment, and follow-up (Byun et al., 2020), Prevention is positively correlated with the development of infrastructures and the effectiveness of healthcare systems, the choice of diagnostic test and treatment approaches mainly relies on accessibility and cost, (Sonnenberg, & Genta, 2020), Therefore, quantifying and benchmarking health systems’ performance is crucial yet challenging to provide a clearer picture of the potential global inequities in the quality of care.
The prevalence of peptic ulcers in Uganda is not well established due to limited research studies in the country (Milivojevic, & Milosavljevic, 2020), However, according to a study conducted in Kampala, the capital city of Uganda, the prevalence of Helicobacter pylori infection, which is a common cause of peptic ulcers, was found to be 78.6% among dyspeptic patients (patients with indigestion, stomach pain, or discomfort). The study also found that 50.6% of the dyspeptic patients had peptic ulcers (Milivojevic, & Milosavljevic, 2020).
Another study conducted in the southwestern region of Uganda among patients with upper gastrointestinal symptoms found that 54% of the patients had H. pylori infection, and 32% had peptic ulcers, these studies suggest that peptic ulcers are a common health problem in Uganda, particularly among dyspeptic patients and those with upper gastrointestinal symptoms (Tarasconi et al., 2020).
2.1.2 Peptic ulcers disease
Peptic ulcer disease (PUD), a common disorder of the digestive system, is defined as digestive tract injury that results in a mucosal break greater than 3–5 mm, with a visible depth reaching the submucosa. Mainly occurring in the stomach and proximal duodenum, PUD accounts for an estimated lifetime prevalence of 5–10% and an annual incidence of 0.1–0.3% in the general population in Western countries. Due to nonspecific symptoms, PUD assessment and treatment requires clinical caution due to severe complications such as bleeding, perforation, penetration into adjacent organs and gastrointestinal obstruction, all of which could require acute endoscopic or surgical treatment (Bereda, 2022).
Peptic ulcers are discontinuities of the gastric or duodenal mucosa with penetration to the muscularis mucosae and exposure of the submucosa [1, 2]. Primitive ulcers are caused by alterations of the gastric function (i.e., increased HCl production and pepsin function); they are mainly single lesions and are usually found at the small gastric curve and at the antrum. Secondary ulcers, on the contrary, are caused by extragastric pathogenic events, that is, stress or drugs. They can be multiple and can have a spread localization within the stomach. More than 20% of patients have a family history of duodenal ulcers. In up to one third of patients with duodenal ulcers, basal acid output (BAO) and maximal acid output are increased. A study by Schubert and Peura [3] attested that individuals are at especially high risk those with a basal acid production (BAP) greater than 15 mEq/h. In addition to the increased gastric and duodenal acidity observed in some patients with duodenal ulcers, accelerated gastric emptying is also often present. A common cause of peptic ulcers in the pediatric age is Helicobacter pylori (HP) infection [4–6], though the use of nonsteroidal anti-inflammatory agents (NSAIDs), like aspirin and ibuprofen, represents a significant cause of ulcers as well [7]. Other treatments comprehending steroids and antineoplastic and immunosuppressive drugs can be causative of peptic ulcers. A reduction of the protective effect of prostaglandins on gastric mucosa is considered to be the main pathogenic mechanism. Other stressful events (i.e., shock, sepsis, burnings, major trauma, intracranial hypertension, surgical procedures, and chronic diseases) can provoke acute gastric ulcers, also in the pediatric age [8]. Lesions generally appear 3–6 days after the event and the main related symptoms are bleeding and
Peptic ulcers are open sores that develop on the lining of the stomach, small intestine, or esophagus, and can cause a range of symptoms. Some of the common symptoms of peptic ulcers include; Abdominal pain: This is the most common symptom of peptic ulcers. The pain is usually felt in the upper abdomen, and it can be either sharp or dull. The pain may be relieved by eating, but it may come back again a few hours later, Indigestion: This is a feeling of discomfort or fullness in the upper abdomen, which may be accompanied by bloating, belching, or nausea, Heartburn: This is a burning sensation in the chest or throat, which may be accompanied by a sour taste in the mouth. Loss of appetite: This is a common symptom of peptic ulcers, which may be due to the pain or discomfort associated with eating, Weight loss: This may occur if the patient avoids eating due to the pain or discomfort associated with peptic ulcers, Nausea and vomiting: These symptoms may occur in some cases, especially if the ulcer is located in the stomach and Black or tarry stools: This may indicate bleeding in the stomach or small intestine, which requires immediate medical attention (Stechmiller et al., 2019).
As a result of some medications such non-steroidal anti-inflammatory drugs (NSAIDS), gastric acids, and pepsin, peptic ulcers are described as a break in the continuity of the mucosa of the stomach or duodenum that eventually results in lesions in the intestinal mucosa (Verma et al., 2010). In essence, the word “peptic” comes from the Greek word “peptikos,” which has a meaning connected to digestion. According to several findings, patients in the older age groups are more likely to develop stomach ulcers. Duodenal ulcer risk is higher in younger people ( Pahwa et al., 2011).
Similar to several digestive disorders, the prevalence of PUD initially increased and then subsequently decreased, PUD epidemiological data spanning 150 years and found that the incidence of and mortality due to PUD increased markedly during the nineteenth century and then decreased steadily due to improvements in environmental hygiene and medical therapeutic strategies. During the first 50 years of the twentieth century in the United States, PUD affected approximately 10% of the adult population (Kowada, & Asaka, 2022).
Gastric colonization with Helicobacter pylori (HP) causes peptic ulcer (PU) in about 10% – 15.0%, gastric adenocarcinoma in about 1% – 30%, and gastric mucosa-associated lymphoid tissue (MALT) lymphoma in less than 1% of cases. Helicobacter pylori-linked virulence elements, the host’s genetic and immunological parameters, and environmental parameters execute critical roles in the development of HP-induced gastrointestinal diseases (Romstad et al., 2022), The cytotoxin-associated gene A (cagA) is known as the strongest virulence agent of HP, and CagA+ bacteria lead to more serious consequences such as PU and malignancy. Diverse kinds of immune cells, including neutrophils, eosinophils, dendritic cells (DCs), natural killer cells, and T and B lymphocytes accumulate into the gastric mucosa during HP infection (El-Dakroury et al., 2022).
Several studies which were conducted in the past 20–30 years indicated a sharp decreasing tendency in the PUD prevalence, PUD-related hospital admissions and PUD-associated mortality due to new anti-PUD therapies application, such as Helicobacter pylori (H. pylori) eradication and proton-pump inhibitors (PPIs) using. However, the widespread use of nonsteroidal anti-inflammatory drugs (NSAIDs), histamine receptor antagonists, and selective serotonin reuptake inhibitors, as well as increased physiological stress, have been reported as risk factors and have changed the landscape of PUD in recent years. The details of the epidemiological changes caused by these relatively new risk factors are still controversial (Wattanaphraya et al., 2021).
The pathogenesis of peptic ulcer disease involves a complex imbalance between gastric offensive mucosal factors like prostaglandins (PG’s), gastric mucus, cellular renewal, blood flow, mucosal cell shedding, glycoproteins, mucin secretion, proliferation, and antioxidant enzymes like catalase (CAT), scavenger, and Helicobacter pylori (H.pylori), as well as defensive mucosal factors like (Wattanaphraya et al., 2021), The location and severity of the disease can be used to classify peptic ulcers. The development of peptic ulcers is also influenced by a number of additional factors, such as tumor necrosis factor, reactive oxygen species (ROS), histamine release, the incidence of apoptosis, and the secretion of bile acids (Gupta et al., 2021).
2.1.3 Medicinal plants with anti-ulcer properties
The acceptance and use of herbal medicine is on the increase globally. In Africa the situation is not different, over 80 % of the population particularly in the developing countries depends directly on plants for their primary healthcare requirements (Russell et al., 2020), In the East African region countries such as Burundi and Tanzania that neighbor Uganda, the population using traditional medicine is also well above 80 % particularly in the rural areas. Plants form an important part of health care especially for the rural poor in Uganda (Kaggwa et al., 2022), The Ugandan government has specifically up scaled the use of herbal medicine and is in the process of integrating it into the main health care system. The noted increased use of herbal medicine is as a result of the confirmed therapeutic evidence of the herbal remedies (Mao et al., 2019), This has been enhanced by the consequences of limited access to modern health services in most developing countries including Uganda, high cost of modern medicine compared to the indigenous herbal medicines, wide socio-cultural acceptance of traditional medicine and the belief that natural products pose no risk (Ssenku et al., 2022).
It’s important to note that while these plants have shown anti-ulcer properties in studies, they have not been specifically proved scientifically, Aloe vera has been traditionally used as a natural remedy for various digestive issues, including ulcers. Some studies have shown that the gel from the aloevera plant can help to soothe and heal damaged digestive tissue, including ulcers. Additionally, aloevera has anti-inflammatory and antioxidant properties that can help to reduce inflammation and oxidative stress in the digestive tract, which can contribute to the development of ulcers, It’s important to note that while aloevera has shown promising results in treating ulcers in laboratory and animal studies, more research is needed to determine its efficacy in human subjects (Dinat, Orchard, & Van Vuuren, 2022),Also, consuming aloevera orally can have negative side effects, such as abdominal cramps, diarrhea and electrolyte imbalances (Teshome et al., 2019).
Because of their cost, accessibility, desire for individualized health care, and fear of the negative effects associated with synthetic drugs, natural goods have remained the drugs of choice for some people due to their safety and efficacy. Also, usage increases as new infectious diseases emerge and conventional medications fail to treat diseases like cancer (Akinwumi, & Sonibare, 2019). In affluent nations, 80% of people utilize traditional remedies made from plants, whereas more than 30% of pharmaceuticals now have some connection to plants, either directly or indirectly. Out of the 252 drugs on the World Health Organization’s (WHO) list of essential medicines, 11% are entirely plant-based, and 122 plant-derived drugs have 80% of their uses related to their original ethnopharmacological purposes. It is estimated that 25% of all drugs prescribed globally are derived from plants (Kuna, et al., 2019).
All around the world, traditional green vegetables are an excellent and affordable source of nourishment for a balanced diet. These vegetables also function as traditional medicines for ailments like toothache (Amaranthus viridis L.), acute abdominal pain (Celosia argentia L.), painful urination (Portulacaoleracea L.), headache (Smithia sensitiva Ait. ), diarrhea (C. mimosoides L.), rheumatism and cough (Marsileaminuta Linn), and helminthes infestation (Spinaciaoleracea Linn.) (Kuna et al., 2019).
Traditional vegetables in Uganda are plant species that are either native to the country or were introduced there in the past, are now being cultivated, and whose leaves are added as a sauce to the basic dishes. All of the country’s geographical regions support a variety of species (Crawford, 2019), However, the extent of their production and consumption varies according to the local behaviors, beliefs, and staple foods of the populace as well as soil and climate types. While some of these traditional vegetables are grown and harvested as wild or semi wild vegetation, others have been domesticated (Mintah et al., 2019).
The vegetables contain vitamins (A, B, and C) and proteins and minerals such as iron, calcium, phosphorus, iodine, and fluorine in varying amounts but adequate for normal growth and health. According to the FAO Food Balance Sheet for Uganda, traditional food plants supply about 90% energy, 76% protein and 63% fat, and most of vitamins A and C, iron, and dietary fiber (Shedoeva,, Leavesley, Upton, & Fan, 2019), These food values are vital necessities for normal growth and defense against protein/calorie malnutrition in humans. Traditional vegetables ensure a well-balanced diet in rural areas. In some cases, parts of traditional vegetable species serve as staple foods such as the mature fruits of C. maxima and the tubers of C. benghalensis, Ipomoea spp., M. esculenta, and S. edule (Zougagh et al., 2019).
Licorice (Glycyrrhiza glabra) is a plant that has been used in traditional medicine for centuries. Its root is the part that is commonly used for medicinal purposes. In traditional medicine, licorice is used for a variety of digestive issues, including ulcers. Studies have shown that licorice has anti-ulcer properties due to its ability to increase the production of mucus in the digestive tract, which can help to protect the lining of the stomach and intestines from damage. Additionally, licorice has anti-inflammatory and antioxidant properties that can help to reduce inflammation and oxidative stress in the digestive tract, which can contribute to the development of ulcers (Tabuti, 2018).
It’s important to note that while licorice has shown promising results in treating ulcers in laboratory and animal studies, more research is needed to determine its efficacy in human subjects. Consuming large amounts of licorice can also have negative side effects, such as high blood pressure, water retention and potassium depletion.
Licorice (Glycyrrhiza glabra) root has been traditionally used for its anti-ulcer properties. Some studies have shown that compounds in licorice root can help to soothe and heal damaged digestive tissue, including ulcers (Musoke, 2019), Additionally, licorice has anti-inflammatory and antioxidant properties that can help to reduce inflammation and oxidative stress in the digestive tract, which can contribute to the development of ulcers (Nakaziba et al., 2021).
The main active component in licorice root responsible for its anti-ulcer properties is glycyrrhizin. Glycyrrhizin has been shown to increase the production of mucus in the digestive tract, which can help to protect the lining of the stomach and intestines from damage and reduce the risk of ulcers (Kuna et al., 2019).
It’s important to note that while licorice has shown promising results in treating ulcers in laboratory and animal studies, more research is needed to determine its efficacy in human subjects. Additionally, consuming large amounts of licorice or licorice supplements can have negative side effects, such as high blood pressure, water retention and potassium depletion (Wang et al., 2019).
Ginger (Zingiber officinale) is a well-known spice that has been used in traditional medicine for centuries. Its root is the part that is commonly used for medicinal purposes. In traditional medicine, ginger is used for a variety of digestive issues, including ulcers (Shahrajabian ,& Cheng, 2019), Studies have shown that ginger has anti-ulcer properties due to its ability to reduce inflammation in the digestive tract and protect the lining of the stomach from damage. Additionally, ginger has antioxidant properties that can help to reduce oxidative stress in the digestive tract, which can contribute to the development of ulcers (Sistani et al., 2019).
It’s important to note that while ginger has shown promising results in treating ulcers in laboratory and animal studies, more research is needed to determine its efficacy in human subjects. Additionally, consuming large amounts of ginger or ginger supplements can have negative side effects, such as gastrointestinal distress, heartburn, and increased bleeding risk (Balogun, deyeOluwa, & Ashafa, 2019).
Ginger (Zingiber officinale) is a well-known spice that has been traditionally used for its anti-ulcer properties. Some studies have shown that ginger can help to soothe and heal damaged digestive tissue, including ulcers. Additionally, ginger has anti-inflammatory properties that can help to reduce inflammation in the digestive tract and protect the lining of the stomach from damage, ginger also has antioxidant properties that can help to reduce oxidative stress in the digestive tract, which can contribute to the development of ulcers (Balogun, AdeyeOluwa, & Ashafa, 2019).
The anti-ulcer effects of ginger are believed to be due to the presence of compounds such as gingerols and shogaols, which have been shown to have anti-inflammatory and antioxidant properties. It’s important to note that while ginger has shown promising results in treating ulcers in laboratory and animal studies, more research is needed to determine its efficacy in human subjects. Additionally, consuming large amounts of ginger or ginger supplements can have negative side effects, such as gastrointestinal distress, heartburn, and increased bleeding risk (Imo, & Za’aku, 2019).
Marshmallow (Althaea officinalis) is a plant that has been used in traditional medicine for centuries. Its root and leaves are the parts that are commonly used for medicinal purposes. In traditional medicine, marshmallow is used for a variety of digestive issues, including ulcers. Studies have shown that marshmallow has anti-ulcer properties due to its ability to soothe and protect the lining of the digestive tract, including the stomach and intestines (Aafreen et al., 2019), Marshmallow contains mucilage, a type of soluble fiber that can form a protective gel-like layer over the digestive tract, helping to reduce irritation and prevent further damage (Alsherbiny et al., 2019).
It’s important to note that while marshmallow has shown promising results in treating ulcers in laboratory and animal studies, more research is needed to determine its efficacy in human subjects. Additionally, consuming large amounts of marshmallow or marshmallow supplements can have negative side effects, such as gastrointestinal distress (Jacob, 2020), As always, it’s best to consult with a healthcare professional before using marshmallow for any health purposes. Chamomile (Matricaria chamomilla) is a plant that has been used in traditional medicine for centuries, particularly for its calming and soothing properties. The flowers of the chamomile plant are the part that is commonly used for medicinal purposes. In traditional medicine, chamomile is used for a variety of digestive issues, including ulcers (Shin et al., 2020).).
Studies have shown that chamomile has anti-ulcer properties due to its ability to reduce inflammation in the digestive tract and protect the lining of the stomach and intestines. Chamomile contains compounds, such as apigenin and chamazulene, that have been shown to have anti-inflammatory and antioxidant properties (Phumthum,& Balslev, 2020).
It’s important to note that while chamomile has shown promising results in treating ulcers in laboratory and animal studies, more research is needed to determine its efficacy in human subjects. Additionally, consuming large amounts of chamomile or chamomile supplements can have negative side effects, such as allergic reactions in some individuals. As always, it’s best to consult with a healthcare professional before using chamomile for any health purposes.
Slippery elm (Ulmus rubra) is a tree native to North America that has been used in traditional medicine for centuries. Its inner bark is the part that is commonly used for medicinal purposes. In traditional medicine, slippery elm is used for a variety of digestive issues, including ulcers. Studies have shown that slippery elm has anti-ulcer properties due to its ability to soothe and protect the lining of the digestive tract, including the stomach and intestines. Slippery elm contains mucilage, a type of soluble fiber that can form a protective gel-like layer over the digestive tract, helping to reduce irritation and prevent further damage (Phumthum, M., & Balslev, 2020).
Additionally, slippery elm has been shown to have anti-inflammatory and antioxidant properties, which can help to reduce inflammation in the digestive tract and protect against oxidative stress, which can contribute to the development of ulcers. It’s important to note that while slippery elm has shown promising results in treating ulcers in laboratory and animal studies, more research is needed to determine its efficacy in human subjects (Shahrajabian et al., 2020).).
Callistemon citrinus (Curtis) Skeels, also known as Lemon Bottlebrush, is a plant species that belongs to the family Myrtaceae. While there are some studies on the potential health benefits of Callistemon citrinus, there is currently limited scientific evidence to support its use for the treatment or prevention of ulcers (Daharia et al., 2022), That being said, some studies have suggested that Callistemon citrinus may have anti-inflammatory and antioxidant properties, which could potentially be beneficial for reducing inflammation and oxidative stress in the digestive tract. These effects may be helpful in preventing the development of ulcers or promoting their healing (Tanveer et al., 2020).
The acceptance and use of herbal medicine is on the increase globally, In Africa the situation is not different, over 80 % of the population particularly in the developing countries depends directly on plants for their primary healthcare requirements (Bhargava et al., 2020), In the East African region countries such as Burundi and Tanzania that neighbor Uganda, the population using traditional medicine is also well above 80 % particularly in the rural areas. Plants form an important part of health care especially for the rural poor in Uganda. The Ugandan government has specifically up scaled the use of herbal medicine and is in the process of integrating it into the main health care system (Daharia et al., 2022), The noted increased use of herbal medicine is as a result of the confirmed therapeutic evidence of the herbal remedies. This has been enhanced by the consequences of limited access to modern health services in most developing countries including Uganda, high cost of modern medicine compared to the indigenous herbal medicines, wide socio-cultural acceptance of traditional medicine and the belief that natural products pose no risk (Mohammed et al., 2020).
The increased preference of herbal medicine has consequently propelled the search for pharmaceutical remedies against different ailments from plants. The medicines are collected from the wild and this has negatively impacted on the plant resource due to unsustainable exploitation rates as well as the health of many people who cannot afford orthodox medicine. This makes documentation, sustainable utilization as well as conservation essential (Bischoff-Kont, et al., 2021), The first step in conservation is to document material traditionally used to treat an ailment. Previous studies have identified and documented numerous medicinal plants for treatment of various diseases in Uganda however these have been targeting specific ailments and are not detailed in shared use (Fakhri et al., 2021), A larger number of medicinal plants and indigenous uses have not yet been documented. The rich history of African cultures and their innovative utilization of plants as a source of remedies have been passed down through generations largely by oral tradition (Patra, et al., 2021), This knowledge is gradually being lost as the custodians die before passing on information to the younger generations. Besides the gradual loss of ethnobotanical knowledge due to lack of documentation, overharvesting of medicinal materials from their natural habitat has been one of the major threats of traditional medicine (Zougagh et al., 2019).
Callistemon citrinus (Curtis) skeels; Callistemon citrinus, also known as the lemon bottlebrush or crimson bottlebrush, is a species of flowering plant in the myrtle family Myrtaceae. It is native to Australia and is widely cultivated as an ornamental plant in many countries. The species was first described by Curtis in 1775, and the authority for its name is Curtis, followed by Skeels in 1913. The name Callistemon citrinus refers to the lemon-scented foliage and the bright red, bottlebrush-like flowers that it produces (Imade, et al., 2022).
There is limited scientific research on the anti-ulcer properties of Callistemon citrinus (Curtis) Skeels. However, some studies have reported that the plant and its extracts have anti-inflammatory and antioxidant effects, which could potentially have a beneficial effect on the prevention and treatment of ulcers.
For example, a study published in the Journal of Ethnopharmacology found that an ethanol extract of Callistemon citrinus showed potent antioxidant activity and exhibited anti-inflammatory effects in vitro. Another study published in the same journal found that a methanol extract of the plant had a protective effect against experimentally induced ulcers in rats.
It is important to note that these studies were conducted in laboratory settings and further research is needed to establish the anti-ulcer properties of Callistemon citrinus in humans. It is not recommended to self-medicate with this plant or its extracts as they may have potential side effects and interactions with other medications. If you are experiencing symptoms of an ulcer, it is best to consult with a healthcare professional for proper diagnosis and treatment.
Callistemon citrinus, commonly known as the lemon bottlebrush, has been studied for its potential health benefits, including its anti-ulcer properties.
Studies have shown that the extract of Callistemon citrinus has anti-ulcer activity, which means it may help to protect the digestive tract from developing ulcers. This is thought to be due to the presence of certain compounds in the plant, such as flavonoids and tannins, which have been shown to have anti-inflammatory and antioxidant properties.
However, it’s important to note that these studies have primarily been conducted in animals, and more research is needed to determine the effectiveness and safety of using Callistemon citrinus as an anti-ulcer treatment in humans. It is also important to remember that self-treating with the plant extract without the supervision of a healthcare provider can be dangerous and could interact with any medications you may be taking.
Callistemon citrinus (Curtis) Skeels; Callistemon citrinus (Curtis) Skeels is a plant species commonly known as the crimson bottlebrush or lemon bottlebrush. It belongs to the family Myrtaceae and is native to Australia (Kumar et al.,2020).
The plant typically grows up to 6 meters tall and has dark green, lance-shaped leaves that are about 10 centimeters long. The crimson bottlebrush is named for its distinctive, bottlebrush-like flowers that are bright red and bloom in late spring and early summer. The flowers are made up of numerous stamens, giving them a feathery appearance (Laganà et al., 2020).
The plant is popular in landscaping due to its attractive foliage and showy flowers. It prefers well-drained soil and full sun exposure, and is relatively easy to care for. In addition to its ornamental value, the crimson bottlebrush is also used in traditional medicine, with its leaves and flowers having been used to treat a variety of ailments including coughs, colds, and sore throats (El-Dakroury et al., 2022).
2.2 Treatment of peptic ulcers
One of the medications prescribed the most frequently for gastroduodenal ulcers is proton pump inhibitors (PPIs). Omeprazole and lansoprazole are the PPI members that are prescribed the most frequently. PPIs are prescribed for both off-label and prescription-based conditions. PPIs have been approved by the FDA for the treatment of GERD, Zollinger Ellison disease, NSAID-activated gastroduodenal ulcer, hemorrhagic ulcer, and gastroduodenal ulcer with stomach inflammation. While PPIs are effective at reducing symptoms, studies have shown that they are among overused medications. This is because they are simple to obtain, even over the counter (OTC), and up to 70% are surprisingly used outside of their intended indications (Merkhan, Abdullah, & Althanoon, 2022).
Despite renal disorders being uncommon, they are serious and might include interstitial nephritis and kidney damage. Other serious but uncommon adverse effects include osteoporosis, hypomagnesemia, anemia, and renal disorders including anemia. The greatest harmful effects of PPIs are thought to be kidney-related adverse events (Jafari et al., 2022).
These renal illnesses may be mistaken with other problems that coexist with the use of PPIs and may actually be the root of the renal disorder, with PPIs only being able to play an additional, extreme mode of induction. The immunological point is a common factor among all of these disorders as an underlying cause of various renal ailments. Among people with the same demographic characteristics who do not take PPIs, renal issues are three times more likely to occur among PPI users. Due to the lack of specific, objectively measurable characteristics supporting the association, the conclusions of the majority of published data are difficult to interpret, the explanation of the association between PPI use and the development of renal problems is based on the precipitation of these drugs together with their metabolites in renal interstitium (Reusens et al., 2017). These later effects stimulate local immune response resulting in T cell stimulation and propagation of immune response which might end up with tissue necrosis and this will ensure discontinuing the offending drugs and start corticosteroids to avoid initiation of renal failure (Imade et al., 2022).
The treatment of peptic ulcers depends on the underlying cause, which can be attributed to infection with the bacterium Helicobacter pylori, long-term use of non-steroidal anti-inflammatory drugs (NSAIDs), excessive alcohol consumption or stress, the following are some common treatment options for peptic ulcers; Antibiotics: If the ulcer is caused by H. pylori, a course of antibiotics is prescribed to kill the bacteria. Usually, two or more antibiotics are used in combination with a proton pump inhibitor (PPI) and/or bismuth subsalicylate. This is known as triple therapy or quadruple therapy (Bereda, 2022)..
Proton pump inhibitors (PPIs): These drugs reduce the amount of acid produced in the stomach and help to relieve pain and promote healing of the ulcer. PPIs are commonly used in combination with antibiotics to treat H. pylori infection, H2 blockers: These drugs also reduce the amount of acid produced in the stomach and help to relieve pain and promote healing of the ulcer, Antacids: These medications neutralize stomach acid and can provide temporary relief of symptoms. They are often used in combination with other medications for more effective treatment and Lifestyle changes: Making lifestyle changes such as reducing stress, avoiding smoking and excessive alcohol consumption, and eating a healthy diet can help to reduce the risk of developing peptic ulcers and promote healing of existing ulcers (Kowada, & Asaka, 2022).
2.2 Isolation and purification of the Bio-active compounds in the extracts
Isolation and purification of bioactive compounds from extracts can be a complex process, but there are some general steps that can be followed. The specific techniques used will depend on the nature of the compounds and the properties of the extract. Here is a general overview of the steps involved in isolating and purifying bioactive compounds:
Extraction: The first step is to extract the bioactive compounds from the source material using an appropriate solvent. Different solvents can be used depending on the polarity and solubility of the compounds of interest.
Fractionation: Once the compounds have been extracted, the next step is to separate them into different fractions based on their physical and chemical properties. This can be done using techniques such as liquid-liquid extraction, column chromatography, or high-performance liquid chromatography (HPLC).
Identification: After fractionation, the fractions containing the bioactive compounds are identified using analytical techniques such as UV-vis spectroscopy, mass spectrometry, or nuclear magnetic resonance (NMR) spectroscopy.
Purification: The final step is to purify the bioactive compounds from the identified fractions. This can be done using techniques such as recrystallization, distillation, or preparative HPLC.
Medicinal plants are useful in the treatment of many ailments and diseases among rural dwellers, indigenous users, traditional medicine (TM) practitioners, and livestock owners in many African countries. The traditional knowledge of medicinal plants if harnessed, can give insights into the vital role that medicinal plants play in drug development.
Often, a single medicinal plant can have multiple uses, and sometimes different parts of the same plant may be used for the treatment of more than one disease condition. Other times, the same plant could be used as an ingredient in herbal preparations for a synergistic effect. This is made possible due to the range of phytochemicals that are present in medicinal plants along with their diversities of bioactivities. Neorautanenia mitis (A. Rich) Verdc. (Fabacae), Hydnora abyssinica A. Braun (Hydnoraceae), and Senna surattensis (Burm. f.) H. Irwin and Barneby (Fabaceae), were selected based on their promising preliminary screening results, they have shown various bioactivities and are traditionally used for the treatments of many disease conditions. The roots of N. mitis, are used for the treatment of bilharzia, syphilis, diarrhea, skin infection, dysmenorrhea and neuropsychiatric conditions. They are also used as an anticonvulsant, anti-malarial, fish poison, insecticide, and for killing bilharzias-carrying fresh water snails in many African countries. The crude extracts and phytochemical constituents isolated from N. mitis have shown antidiarrheal, acaricidal, insecticidal, antinocicetive, anti-inflammatory, larvicidal, mosquitocidal, cytotoxicity, and antimicrobial, activities. H. abyssinica, is referred to as one of the strangest plants in the world, with its vegetative body consisting of only flowers, fruits and roots and has no leaves. It is not very common among botanists and plant scientists because it is rarely encountered. However, it remains a popular and valuable medicinal plant among local users and TM practitioners, and is traded by traditional medicine vendors in local markets in South Africa, Mozambique and Nigeria. In some African countries including, Sudan, Kenya, South Africa, Malawi, Mozambique and Nigeria, it has been used for, the treatment of diarrhea, severe bacterial infections such as urinary tract infection, helminthiasis, internal wounds, piles, acne and dysentery, the expulsion of retained placenta and the treatment of throat and stomach aches. Extracts and constituents from H. abyssinica showed immunosuppressive, cytotoxic, antibacterial, antioxidant, molluscidal and antidiarrheal activities.
