Skip to main content
NCBI home page
World Journal of Gastroenterology logoLink to World Journal of Gastroenterology
. 2014 Dec 7;20(45):17020–17028. doi: 10.3748/wjg.v20.i45.17020

Efficacy and safety of herbal medicines in treating gastric ulcer: A review

Wei-Ping Bi 1,2,3, Hui-Bin Man 1,2,3, Mao-Qiang Man 1,2,3
PMCID: PMC4258570  PMID: 25493014

Abstract

Gastric ulcer is a common disorder of the digestive system. Current therapeutic regimens largely rely on Western medicine. However, numerous studies have demonstrated that herbal medicines can effectively treat gastric ulcer in humans and various animal models via divergent mechanisms. This review updates the efficacy and safety of herbal medicines in treating gastric ulcer, and the mechanisms of their action in humans and animal models. Studies have demonstrated that the efficacy of herbal medicines is comparable or superior to that of drugs such as omeprazole or cimetidine in humans and animal models, and herbal medicines display fewer adverse effects. The mechanisms by which herbal medicines benefit gastric ulcer include stimulation of mucous cell proliferation, anti-oxidation, and inhibition of gastric acid secretion and H(+)/K(+)-ATPase activity. Some herbal medicines also exhibit antimicrobial properties. Utilization of herbal medicines could be a valuable alternative to treat gastric ulcer in humans effectively, with few adverse effects.

Keywords: Herbal medicines, Gastric ulcer, Mechanism of action

Core tip: Gastric ulcer is a common digestive disorder. Herbal medicines can effectively treat gastric ulcers in humans and various animal models. The efficacy of herbal medicines is comparable or superior to drugs such as omeprazole or cimetidine, and herbal medicines display fewer adverse effects. The mechanisms by which herbal medicines benefit gastric ulcer include stimulation of mucous cell proliferation, anti-oxidation, and inhibition of gastric acid secretion as well as H(+)/K(+)-ATPase activity. Some herbal medicines also exhibit antimicrobial properties. Utilization of herbal medicines could be a valuable alternative to treat gastric ulcer in humans effectively, with few adverse effects.

INTRODUCTION

Gastric ulcer is the most common disorder of the upper digestive tract. The prevalence of gastric ulcer is 2.4% in the Western population[1] and annual incidence rates range from 0.10% to 0.19%[2]. In certain regions of Mainland China, the prevalence of gastric ulcer is as high as 6.07% in the general population, and 22.5% of patients with gastrointestinal symptoms have gastric ulcer[3,4]. Higher incidence usually occurs in people who smoke, use nonsteroidal anti-inflammatory drugs (NSAIDs), or consume alcohol[5-8]. The recurrence rate is as high as 60%[9]. Gastric ulcer has a significant economic impact. Average annual medical costs are $23819 for gastric ulcer in the United States[10]. In South Korea, the annual medical costs for gastric ulcer range from $959.6 to $2553.10[11]. Although some studies have demonstrated that Helicobacter pylori (H. pylori) eradication therapy is cost-effective[12], a more systematic study indicated that there was no significant cost difference per subject between eradication therapy and placebo[13]. Although conventional regimens are effective, their side effects are often inevitable and limit clinical utility[14-16]. However, both clinical and experimental studies have demonstrated that herbal medicines exhibit therapeutic benefit for gastric ulcer with fewer side effects. Moreover, the cost of herbal medicine for gastric ulcer is only about one-sixth of that of Western medicine[17]. In this paper, the efficacy, safety and mechanisms of action of herbal medicines in treating gastric ulcer are reviewed.

EFFICACY OF HERBAL MEDICINES

Animal models

The beneficial effects of herbal medicines in treating gastric ulcer are demonstrated primarily in various animal models, including ulcers induced by NSAIDs, ethanol, cold-restraint stress, pylorus ligation, as well as erosive agents. In each model, the therapeutic efficacy varies depending on the preparation and utilization of herbal medicines.

NSAID-induced gastric ulcer model: Induction of gastric ulcer is a major adverse effect caused by NSAIDs. Therefore, they have been used widely to establish animal models of gastric ulcer. A single dose of oral indomethacin can induce gastric ulcer-like damage in rats, which reaches a maximum 3 d after administration[18,19]. Oral administration of Myristica malabarica extract once daily for 3 d induced a > 60% reduction in macroscopic damage score[18]. Similarly, oral Piper betel extract at a dose of 2 mg/kg per day for 7 d significantly reduced ulcer index in a rat model of indomethacin-induced gastric ulcer[20]. Its efficacy was comparable to misoprostol, a conventional anti-ulcer drug. Mehrabani et al[21] have reported that oral Teucrium polium extract lowered ulcer index in 24 h and induces a > 90% reduction in ulcer index. Likewise, oral administration of Phyllanthus emblica fruit extract for 7 d induced 79.39% inhibition of ulcer index[22]. Moreover, oral beeswax extract for 5 d induced significant acceleration of ulcer healing in a rat model[23]. These results suggest that herbal medicines could be useful in treating NSAID-induced gastric ulcer.

Acetic acid-induced gastric ulcer model: A gastric ulcer model can be established by injection or topical application of acetic acid solution into the stomach. Oral Qualea grandiflora extract once daily for 14 d accelerated ulcer healing in an acetic acid-induced gastric ulcer model (ulcer area 6.86 ± 1.46 mm2 for control, 1.13 ± 1.3 mm2 for Qualea grandiflora extract, and 1.63 ± 1.11 mm2 for cimetidine)[24]. Oral Centella asiatica for only 3 d also resulted in dose-dependent acceleration of ulcer healing[25]. Dharmani et al[26] reported that oral administration of Ocimum sanctum Linn at a daily dose of 100 mg/kg for 10 d achieved a comparable efficacy to omeprazole in ulcer healing in an acetic acid-induced gastric ulcer model. In some cases, the efficacy of herbal medicines is superior to that of conventional drugs. For example, oral Alchornea glandulosa extract at a dose of 250 mg/kg per day for 14 d achieved a higher curative rate than cimetidine[27]. Moreover, administration of extract of herbal mixture also benefited ulcer healing[28] and reduced recurrence rates[29]. Oral Bacopa monniera or Azadirachta indica extract for 5 d not only accelerated gastric ulcer healing in normal rats, but also in rats with type 2 diabetes mellitus[30]. The efficacy of herbal extracts on ulcer healing varies with molecular size. For instance, lower molecular weight chitosan is more potent than high molecular weight chitosan in treating gastric ulcer induced by acetic acid[31]. One study showed that following induction of gastric ulcer, rats were given oral Salvia miltiorrhiza at 840 mg/d for 5 d, followed by 410 mg/d for 25 d. Cimetidine was used as a positive control. Ulcer index was significantly lower in Salvia miltiorrhiza-treated than cimetidine-treated rats. Further improvement in ulcer was observed 3 mo after Salvia miltiorrhiza treatment[32]. Herbal medicines that benefit gastric ulcer are listed in Table 1[18-55].

Table 1.

Efficacy and safety of herbal medicines for gastric ulcer in animal models and possible mechanisms

Herbal extracts Model Treatment course (d) Efficacy
 Possible mechanisms Adverse effects Ref.
Herbal extract Positive control
Myristica malabarica NSAID 3 62%-86%1 76%-79%1 ↑ EGF, ↑ VEGF, ↓ endostatin None [18]
Piper betel NSAID 7 93.4%2 85.4%2 Antioxidant, ↑ mucus content N/D [20]
Teucrium polium NSAID 28 90%2 N/D ↑ Proliferation, ↓ inflammation N/D [21]
Phyllanthus emblica fruits NSAID 7 80%2 N/D Antioxidant N/D [22]
Beeswax NSAID, acetic acid 3 h for NSAID, 5 d for acetic acid 56%3 for NSAID; 65.8%3 for acetic acid N/D N/D N/D [23]
Qualea grandiflora Acetic acid 14 83%4 76%4 ↑ Mucus production, ↑ Proliferation, ↓ acid secretion N/D [24]
Centella asiatica Acetic acid 7 50%4 N/D ↑ bFGF, ↑ proliferation, ↓ MPO N/D [25]
Ocimum sanctum Linn. Acetic acid 20 92.75%2 87%2 ↑ Mucin content, ↑ proliferation, ↓ acid secretion N/D [26]
Alchornea glandulosa Acetic acid 14 43%4 16%4 ↑ Proliferation, ↓ acid secretion None [27]
Radix Bupleuri, Radix Codonopsis, radix paeoniae alba, rhizoma corydalis, rhizoma bletilla, margarita, indigo naturalis, radix glycyrrhizae IL-1b, acetic acid 7-92 56%2 at 7 d, 12.5% recurrence rate at 92 d 27%2 at 7 d, 25% recurrence rate at 92 d ↑ VEGF, ↓ inflammation, ↑ Microvasculature density, ↓ NF-κB mrna and protein N/D [28,29]
Bacopa monniera Acetic acid 10 85.9%2 in normal; 52.5%2 in diabetes rats 68%2 in normal; 41.8%2 in diabetes rats N/D N/D [30]
Azadirachta indica Acetic acid 10 65.6%2 in normal; 71.5%2 in diabetic rats 68%2 in normal; 41.8%2 in diabetic rats N/D N/D [30]
Chitosan, chitin Acetic acid 14 60%2 46%2 ↓ Acid secretion, ↑ mucus N/D [31]
Salvia miltiorrhiza Acetic acid 5-30 31%2 for 5 d 59%2 for 30 d 19%2 for 5 d 33%2 for 30 d ↑ Proliferation N/D [32]
Ganoderma lucidum Acetic acid 14 55.9%2 82.8%2 ↑ Mucus content, ↑ PGE2 N/D [33]
Tea catechin Acetic acid 14 66%2 59%-77%2 Antioxidant N/D [34]
Solanum nigrum Acetic acid 7 70.1%2 75.7%2 H+/K+-atpase activity, ↓ gastrin, ↓ acid secretion None [35]
Cochinchina momordica seed Acetic acid 14 71.2%3 N/D ↑ VEGF (protein and mrna), ↑ Microvasculature density N/D [36]
Rhizoma Coptis Chinensis Acetic acid 10 53.86%3 36.47%3 ↓ Acid secretion N/D [37]
Glycyrrhetic acid, β-sitosterol, berberine, baicalin and ginsenoside Acetic acid ↓ Endothelin-1, ↑ leptin [38]
Curcumin and bisdemethoxycurcumin Acetic acid 10 86.05%4 82.42%4 ↓ iNOS, ↓ acid secretion, ↓ inflammation N/D [39]
Bupleurum falcatum L. Acetic acid 14 51.9%4 83.1%4 N/D N/D [40]
Plantago lanceolata L Acetic acid 10 77.9%2 76.2%2 ↑ Mucus content, ↓ gastric secretion, ↓ acid secretion None [41]
Croton lechleri Acetic acid 7 55%3 N/D ↓ Bacterial colonization, ↓ MPO, ↓ iNOS, ↓ inflammation N/D [42]
Panax notoginseng, rhizoma bletilla, Poria cocos, Taraxacum mongolicum Hand Acetic acid 7 N/D N/D N/D N/D [43]
Tabebuia avellanedae Acetic acid 7 36%3 48%3 ↑ Proliferation, ↑ mucus content N/D [44]
Sea buckthorn bark Acetic acid 14 80%2 70%2 ↑ Plasma EGF, ↑ EGFR, ↑ PCNA N/D [45]
Astaxanthin Acetic acid 10 93.5%3 N/D Antioxidant, ↓ inflammation N/D [46]
Angelica sinensis Acetic acid 3-7 95%3 for 3 d, 62%3 for 7 d N/D ↑ Mucus content N/D [47]
Radix Aristolochiae, Potentilla bifurca L, Resina Draconis, Taraxacum mongolicum Hand, radix paeoniae alba, Saussurea costus (Falc.) Lipech, radix glycyrrhizae Acetic acid 16 N/D N/D ↑ Proliferation, ↑ NO, ↑ EGF N/D [48]
Rhizoma Atractylodis macrocephalae, Radix Linderae, Rhizoma Dioscoreae, rhizoma bletilla, Pericarpium Citri Reticulatae Viride, Rhizoma Alpiniae Officinarum, Radix Paeoniae Rubra, Herba Agrimoniae Acetic acid 14 45.15%4 72.12%4 ↑ Serum EGF, ↑ serum no, ↓ Acid secretion, ↑ PGE2 N/D [49]
Nyctanthes arbortristis Linn Acetic acid 10 55%-60%3 N/D ↓ Inflammation N/D [50]
Radix Codonopsis, Radix Adenophorae, Radix Angelica Sinensis, Rhizoma Chuanxiong, radix paeoniae alba, Poria, Rhizoma Atractylodis macrocephalae, Radix Bupleuri, Radix Scutellariae, Rhizoma Coptidis, Fructus Aurantii Immaturus, Radix Salviae Miltiorrhiza, Taraxacum mongolicum Hand, rhizoma corydali, Panax notoginseng, Radix Glycyrrhizae. Preparata Acetic acid 14 49%3 30%3 ↑ Serum and mucosal EGF, ↑ EGFR N/D [51]
Bacopa monniera HCI 10 91.8%2 in normal; 76.2%2 in diabetes 92.5%2 in normal; 71.5%2 in diabetes N/D N/D [30]
Azadirachta indica HCI 10 93.4%2 in normal; 91.2%2 in diabetes 92.5%2 in normal; 71.5%2 in diabetes N/D N/D [30]
Prumnopitys andina wood and bark Acetic acid 14 92.5%4 79.6%4 ↑ Proliferation, antioxidant (only lipoperoxidation, no change in reduced glutathione content), ↑ PGE2 N/D [52]
Bupleuri Radix, Pinelliae Tuber, Scutellariae Radix Glycyrrhizae, Radix Cinnamomi Cortex, Ginseng Radix, Paeoniae Radix, Zizyphi Fructus, Zingiberis Rhizoma Cold water restraint stress 3 h 24%2 N/D N/D N/D [54]
Coptidis Rhizoma, Scutellariae Radix, Phellodendri Cortex, Gardeniae Fructus Cold water restraint stress 3 h 62%2 N/D Antioxidant N/D [54]
Bupleuri Radix, Paeoniae Radix, Aurantii Fructus Immaturus, Glycyrrhizae Radix Cold water restraint stress 3 h 20%2 N/D N/D N/D [54]
Curcumin pyloric ligation 19 h 90.79%2 N/D Antioxidant, ↓ acid secretion, ↓ inflammation N/D [55]
Open in a new tab
1

Reduction in macroscopic damage score;

2

Reduction in ulcer index;

3

Reduction in ulcer size;

4

Cure rate. bFGF: Basic fibroblast growth factor; MPO: Myeloperoxidase; N/D: Not determined; None: Not toxic; PGE2: Prostaglandin E2; VEGF: Vascular endothelial growth factor.

Other gastric ulcer models: Water immersion restraint stress results in formation of gastric ulcer via oxidative stress[53,54]. Ohta et al[54] reported that oral extracts of several herbal mixtures for 3 h markedly reduced ulcer indices in gastric ulcer models induced by water immersion restraint stress. Similarly, oral curcumin resulted in a dose-dependent reduction of ulcer indices in a pylorus ligation-induced gastric ulcer model[55]. These results demonstrate that herbal extracts of single ingredients or mixtures are beneficial in gastric ulcer healing.

Patients with gastric ulcer

Herbal medicines have been used to treat human gastric ulcer for millennia. Several controlled clinical studies have demonstrated that herbal medicines are effective in treating human gastric ulcer (Table 2). He et al[56] reported that > 86% of patients with gastric ulcer showed improvement after orally given a herbal mixture three times daily for 6 wk. Similarly, oral herbal mixtures two or three times daily for 2 mo induced a > 90% improvement in patients with gastric ulcer[57,58]. Improvement of clinical symptoms occurred as early as 3 d after oral herbal medicines[59]. The efficacy of herbal medicines in treating gastric ulcer is comparable to that of famotidine, a histamine H2-receptor antagonist[60]. Studies have demonstrated that herbal medicine is comparable or superior to cimetidine in treating either gastric[61-64] or duodenal[61,62] ulcers. One study showed that oral herbal medicines for 4 wk achieved superior efficacy to cimetidine in treating gastric and duodenal ulcers, as well as gastritis[65]. Moreover, combination of herbal medicine and ranitidine exhibited a synergistic effect in treating gastric ulcer[66-68]. Herbal medicines effectively cure gastric ulcer and prevent its recurrence. For example, one study showed that oral herbal tablets induced a 62.4% cure rate while the recurrence rate was 17.7% after 1-year follow-up. In contrast, treatment with ranitidine only achieved a 50.7% cure rate, and the recurrence rate was 54.1%[69]. Likewise, oral combination of omeprazole and herbal medicine for 4 wk significantly reduced gastric ulcer recurrence rate (25%) compared with omeprazole alone (57.1%) after 6 mo follow-up[70]. Taken together, these results demonstrate that herbal medicines alone are effective in treating gastric ulcer and preventing recurrence. Combination of herbal medicines and conventional regimens exhibits a synergistic effect in the management of gastric ulcer. Although all mixtures listed in Table 2 are effective for gastric ulcer, herbal medicines should be given according to each patient’s internal conditions as defined by the theory of traditional Chinese medicine in order to gain an optimal benefit.

Table 2.

Efficacy and safety of herbal medicines for gastric ulcer in humans

Herbal extracts No. of patients (M/F) Treatment course (d) Efficacy
 Adverse effects Ref.
Herbal extract Positive control
Rhizoma Coptidis, Radix Sanguisorbae, radix paeoniae alba, rhizoma bletilla, Chickens Gizzard membrane 60 (41/19) 42 Cure rate: 20% Effective rate: 85% Cure rate: 10% Effective rate: 71.67% None [56]
Radix Astragali, Radix Aucklandiae, Fructus Aurantii Immaturus, Cortex Magnoliae Officinalis, Chickens Gizzard membrane, radix notoginseng, radix paeoniae alba, Radix Scutellariae, Radix Glycyrrhizae 50 (35/25) 60 Cure rate: 72% Effective rate: 96% N/D Vomiting in one case [57]
Radix Astragali, radix codonopsis, poria, Rhizoma Atractylodis Macrocephalae, dried orange peel, Radix Glycyrrhizae 841 (43/41) 60 Effective rate: 92.9% N/D N/D [58]
Radix Bupleuri, Radix Codonopsis, radix paeoniae alba, rhizoma corydalis, rhizoma bletilla, margarita, indigo naturalis, radix glycyrrhizae 26 (15/11) 28 Effective rate 92.3% Effective rate 92.3% Temporary diarrhea at beginning [60]
Margarita, borax, Rhizoma Coptidis, rhizoma bletilla, indigo naturalis, amber 90 (N/D) 30 Cure rate: 88.9% Effective rate: 96.7% Cure rate: 82.8% Effective rate: 89.7% None [61]
Rhizoma curculiginis, Herba Epimedii, Radix Astragali, rhizoma bletilla, poria, Fructus Amomi, Radix Glycyrrhizae Preparata 622 (44/18) 30 Cure rate: 82.3% Effective rate: 98.4% Cure rate: 81.4% Effective rate: 93.0% 5 cases had dry mouth; 7 cases had constipation [62]
Radix Codonopsis, Herba Taraxaci, Radix Salviae miltiorrhizae, Rhizoma Atractylodes alba, Radix Glycyrrhizae 30 (22/8) 56 Cure rate: 50% Effective rate: 86.7% Cure rate: 40% Effective rate: 70% N/D [63]
Ramulus Cinnamomi, Radix Paeoniae Alba, Radix Glycyrrhizae Preparata, Rhizoma Zingiberis Recens, Fructus Jujubae, Sacchaium Granorum, Radix Cynanchi Paniculati 80 (58/22) 28 Cure rate: 45% Effective rate: 93.75% Cure rate: 10.26% Effective rate: 74.36% N/D [64]
Radix Astragali, Taraxacum mongolicum Hand, tokyo violet herb, Bulbus Lilii, Radix Linderae, Radix Salvia miltiorrhiza, radix paeoniae alba, Radix Glycyrrhizae 12 (ND) 28 Cure rate: 100% Cure rate: 62.5% N/D [65]
Open in a new tab
1

Including gastritis;

2

Including 41 cases of duodenal ulcer and 4 cases of gastric and duodenal ulcers. M: Male; F: Female; Cure: Clinical symptoms disappeared; Effective: Clinical symptoms improved; N/D: Not determined.

SAFETY

Although herb-drug interactions have raised safety concerns[71,72], and some herbs can cause severe side effects[73,74], herbal medicines used to treat gastric ulcer are generally safe in both animal models and humans. For instance, Myristica malabarica extract at a daily dosage of 40 mg/kg accelerated ulcer healing in a mouse model of indomethacin-induced gastric ulcer[18,19,75]. However, mice treated with oral Myristica malabarica extract at a dose of 500 mg/kg daily for 1 mo showed no observable physical sign of adverse effects. In addition, the histology and function of mouse liver and kidneys appeared normal[18]. Likewise, oral Gualea grandiflora extract at a dose of 500 mg/kg for 14 d induced an 83% cure rate of gastric ulcer induced by acetic acid[24]. Mice fed Gualea grandiflora extract at a dose of 5 g/kg per day for 14 d showed no significant differences in the weight of the heart, liver, kidney or lungs compared with those of the control group. None of the treated mice died during the 14 d of observation[24]. Again, methanolic extract of Alchornea glandulosa at a dose of 250 mg/kg per day was more potent than cimetidine in treating acetic acid-induced gastric ulcer[27]. Oral Alchornea glandulosa at 5 g/kg daily for 14 d caused no significant changes in weight of several organs, such as the liver, kidneys, heart, lungs, as well as spleen. Moreover, there were no dramatic differences in liver and renal function between control and herbal treatment[27]. Furthermore, oral Solanum nigrum extract at a daily dose of 200 mg/kg for 7 d significantly reduced ulcer index (10.1 ± 0.91 for herbal extract vs 16.9 ± 1.4 for controls)[35]. However, oral administration of Solanum nigrum extract at dose of 4 g/kg per day for 14 d caused no changes in red blood cell count, white blood cell count, hemoglobin, hematocrit, or mean corpuscular volume[35]. Finally, a number of clinical studies have demonstrated that herbal medicines are safe for humans. As seen in Table 2, only minimal adverse effects occur following herbal treatment in humans. Although these results indicate that herbal medicines are safe for treating gastric ulcer, special caution should be taken when using herbal medicines because of the potential adverse effects and herb-drug interactions.

MECHANISMS OF ACTION

Studies in humans and animal models suggest that herbal medicines exert their beneficial effects on gastric ulcer via multiple mechanisms, including antioxidant activity, stimulation of mucosal proliferation, inhibition of acid production and secretion, increased mucus production, as well as inhibition of inflammation (Figure 1).

Figure 1.

Figure 1

Open in a new tab

Schematic diagram of possible mechanisms by which herbal medicines benefit gastric ulcer. bFGF: Basic fibroblast growth factor; VEGF: Vascular endothelial growth factor; EGFR: Epidermal growth factor receptor.

Antioxidant activity

The link of oxidative stress and gastric ulcer is well recognized[76]. That some herbal medicines benefit gastric ulcer is likely due to their antioxidant properties. In indomethacin-induced gastric ulcer models, the gastric levels of malondialdehyde (MDA) were increased while the levels of superoxide dismutase (SOD) and catalase (CAT) were decreased[20]. Piper betel extract treatment not only normalized MDA levels, but also significantly increased the levels of SOD and CAT with a comparable efficacy to misoprostol[20]. Oral Phyllanthus emblica fruit extract for 7 d dramatically lowered gastric MDA levels and elevated the contents of reduced glutathione and CAT[22]. Likewise, oral administration of astaxanthin for 10 d not only reduced ulcer area, but also lowered MDA levels, while the activities of mucosal SOD, CAT and glutathione peroxidase (GSH-Px) were significantly increased[46]. Regarding the involvement of NO (a reactive oxygen species), the results were controversial. Some studies showed that herbs that benefit gastric ulcer increased NO content in gastric tissue[48,49,77,78], while others demonstrated that herbal extracts reduced inducible NO synthase[39,41] and NO production[39].

Stimulation of mucosal proliferation

Mucosal proliferation is required for ulcer healing. Certain herbal medicines that promote ulcer healing act via stimulation of cell proliferation. One study showed that oral Centella asiatica for 3 d stimulated cell proliferation and angiogenesis, and increased basic fibroblast growth factor expression[25,60]. Moreover, oral ethanol extract of Tabebuia avellanedae for 7 d also increased cell proliferation in acetic acid-induced gastric ulcer in rats[44]. Stimulation of cell proliferation by herbal medicine could be attributed to upregulation of epidermal growth factor[45,48,49,51] and its receptor expression[45,51,78].

Inhibition of acid production

Inhibition of acid production can improve gastric ulcer[79]. Many herbal medicines with anti-gastric ulcer activity reduce gastric acid secretion (Table 1). For example, oral Ocimum sanctum extract for 3 d induced a > 50% reduction in total gastric acidity[26]. Similarly, oral Solanum nigrum fruits extract at a dose of 400 mg/kg lowered gastric acid concentration comparable to omeprazole (10 mg/kg)[35]. Herbal medicine-induced reduction in acid production could be due to: (1) inhibition of H(+)/K(+)-ATPase activity, as demonstrated in animal models of gastric ulcer[35,50]; or (2) stimulation of prostaglandin E2 production[33,49,52,62,65].

Others

H. pylori infection is closely associated with peptic ulcers[80]. Some herbal medicines that cure gastric ulcer can be attributed, at least in part, to their antimicrobial property. Oral Croton lechleri extract for 7 d induced an about 30% reduction in bacterial colony forming units in acetic acid-induced gastric ulcer[42]. Some herbal extracts exhibit anti-inflammatory activity. For example, oral Centella asiatica extract for 3 d inhibited myeloperoxidase activity, which is a marker of neutrophil infiltration during inflammation[81,82], at the ulcer site[25]. Oral administration of Croton lechleri extract for 7 d resulted in an approximately 70% reduction in myeloperoxidase activity at the ulcer site in a rat model of gastric ulcer[42].

Mucus consisting of mucin provides an important protective barrier against acid and pepsin[83,84]. Certain herbal medicines cure gastric ulcer via increasing mucus production. One study showed that oral Piper betel extract for 7 d normalized gastric mucin levels with a comparable efficacy to misoprostol in a rat model of indomethacin-induced gastric ulcer[20]. Another study revealed that gastric mucus content was normalized 5 h after administration of chitosan at a dose of 250 mg/kg in ethanol-induced gastric ulcer[31]. A clinical study demonstrated that oral herbal mixture for 1 mo significantly increased mucosal MUC5AC (human mucin gene) level in patients with gastric ulcer[66]. Pertinent to mucus, pepsin is also involved in the development of gastric ulcer via degradation of mucus[85]. Studies demonstrated that anti-gastric ulcer herbs decreased pepsin content[57] and activity in pyloric ligation-induced gastric ulcer[49,57]. Collectively, these data indicate that herbal medicines benefit gastric ulcer via divergent mechanisms. The mechanisms whereby each herb or herbal mixture improves gastric ulcer are listed in Table 1.

In summary, herbal medicines are effective in treating gastric ulcer with fewer adverse effects and lower recurrence rates. Combination of herbal medicines and conventional anti-gastric ulcer drugs displays a synergistic effect against gastric ulcer. Thus, herbal medicines alone or in combination with conventional drugs could be used as an alternative for treating certain gastric ulcers and preventing recurrence. Only some anti-gastric ulcer herbal ingredients display antimicrobial properties[42,86], thus, combination of herbal medicines and anti-H. pylori therapy could improve the outcome for patients with gastric ulcer.

ACKNOWLEDGMENTS

The authors are grateful to George Man for his editorial help in English.

Footnotes

P- Reviewer: Rodrigo L, Saha L, Sugimoto M S- Editor: Ma YJ L- Editor: Wang TQ E- Editor: Wang CH

References

  • 1.Groenen MJ, Kuipers EJ, Hansen BE, Ouwendijk RJ. Incidence of duodenal ulcers and gastric ulcers in a Western population: back to where it started. Can J Gastroenterol. 2009;23:604–608. doi: 10.1155/2009/181059. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Sung JJ, Kuipers EJ, El-Serag HB. Systematic review: the global incidence and prevalence of peptic ulcer disease. Aliment Pharmacol Ther. 2009;29:938–946. doi: 10.1111/j.1365-2036.2009.03960.x. [DOI] [PubMed] [Google Scholar]
  • 3.Dong WG, Cheng CS, Liu SP, Yu JP. Epidemiology of peptic ulcer disease in Wuhan area of China from 1997 to 2002. World J Gastroenterol. 2004;10:3377–3379. doi: 10.3748/wjg.v10.i22.3377. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 4.Li Z, Zou D, Ma X, Chen J, Shi X, Gong Y, Man X, Gao L, Zhao Y, Wang R, et al. Epidemiology of peptic ulcer disease: endoscopic results of the systematic investigation of gastrointestinal disease in China. Am J Gastroenterol. 2010;105:2570–2577. doi: 10.1038/ajg.2010.324. [DOI] [PubMed] [Google Scholar]
  • 5.Maity P, Biswas K, Roy S, Banerjee RK, Bandyopadhyay U. Smoking and the pathogenesis of gastroduodenal ulcer--recent mechanistic update. Mol Cell Biochem. 2003;253:329–338. doi: 10.1023/a:1026040723669. [DOI] [PubMed] [Google Scholar]
  • 6.García Rodríguez LA, Hernández-Díaz S. Risk of uncomplicated peptic ulcer among users of aspirin and nonaspirin nonsteroidal antiinflammatory drugs. Am J Epidemiol. 2004;159:23–31. doi: 10.1093/aje/kwh005. [DOI] [PubMed] [Google Scholar]
  • 7.Ko JK, Cho CH. Alcohol drinking and cigarette smoking: a “partner” for gastric ulceration. Zhonghua Yixue Zazhi (Taipei) 2000;63:845–854. [PubMed] [Google Scholar]
  • 8.Bujanda L. The effects of alcohol consumption upon the gastrointestinal tract. Am J Gastroenterol. 2000;95:3374–3382. doi: 10.1111/j.1572-0241.2000.03347.x. [DOI] [PubMed] [Google Scholar]
  • 9.Fujino S, Suzuki Y, Tanaka T. Cost-benefit analysis of medicinal treatment for gastric ulcers. Long-term model including healing and recurrence. Health Policy. 1985;5:45–72. doi: 10.1016/0168-8510(85)90065-x. [DOI] [PubMed] [Google Scholar]
  • 10.Joish VN, Donaldson G, Stockdale W, Oderda GM, Crawley J, Sasane R, Joshua-Gotlib S, Brixner DI. The economic impact of GERD and PUD: examination of direct and indirect costs using a large integrated employer claims database. Curr Med Res Opin. 2005;21:535–544. doi: 10.1185/030079905X38240. [DOI] [PubMed] [Google Scholar]
  • 11.Song HJ, Kwon JW, Kim N, Park YS. Cost Effectiveness Associated with Helicobacter pylori Screening and Eradication in Patients Taking Nonsteroidal Anti-Inflammatory Drugs and/or Aspirin. Gut Liver. 2013;7:182–189. doi: 10.5009/gnl.2013.7.2.182. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 12.Ford AC, Delaney BC, Forman D, Moayyedi P. Eradication therapy in Helicobacter pylori positive peptic ulcer disease: systematic review and economic analysis. Am J Gastroenterol. 2004;99:1833–1855. doi: 10.1111/j.1572-0241.2004.40014.x. [DOI] [PubMed] [Google Scholar]
  • 13.Mason J, Axon AT, Forman D, Duffett S, Drummond M, Crocombe W, Feltbower R, Mason S, Brown J, Moayyedi P. The cost-effectiveness of population Helicobacter pylori screening and treatment: a Markov model using economic data from a randomized controlled trial. Aliment Pharmacol Ther. 2002;16:559–568. doi: 10.1046/j.1365-2036.2002.01204.x. [DOI] [PubMed] [Google Scholar]
  • 14.Schunack W. Pharmacology of H2-receptor antagonists: an overview. J Int Med Res. 1989;17 Suppl 1:9A–16A. [PubMed] [Google Scholar]
  • 15.Bright-Asare P, Habte T, Yirgou B, Benjamin J. Prostaglandins, H2-receptor antagonists and peptic ulcer disease. Drugs. 1988;35 Suppl 3:1–9. doi: 10.2165/00003495-198800353-00003. [DOI] [PubMed] [Google Scholar]
  • 16.Xiao YL, Nie YQ, Hou XH, Xie PY, Fang JY, Yuan YZ, Zhou LY, Zhao NQ, Chen MH. The efficacy, safety and cost-effectiveness of hydrotalcite versus esomeprazole in on-demand therapy of NERD: A multicenter, randomized, open-label study in China. J Dig Dis. 2013;14:463–468. doi: 10.1111/1751-2980.12069. [DOI] [PubMed] [Google Scholar]
  • 17.The cost for treating gastric ulcer. Available from: http://jibing.qiuyi.cn/wky/2013/0509/132036.html.
  • 18.Banerjee D, Maity B, Bandivdeker AH, Bandyopadhyay SK, Chattopadhyay S. Angiogenic and cell proliferating action of the natural diarylnonanoids, malabaricone B and malabaricone C during healing of indomethacin-induced gastric ulceration. Pharm Res. 2008;25:1601–1609. doi: 10.1007/s11095-007-9512-0. [DOI] [PubMed] [Google Scholar]
  • 19.Banerjee D, Bauri AK, Guha RK, Bandyopadhyay SK, Chattopadhyay S. Healing properties of malabaricone B and malabaricone C, against indomethacin-induced gastric ulceration and mechanism of action. Eur J Pharmacol. 2008;578:300–312. doi: 10.1016/j.ejphar.2007.09.041. [DOI] [PubMed] [Google Scholar]
  • 20.Bhattacharya S, Banerjee D, Bauri AK, Chattopadhyay S, Bandyopadhyay SK. Healing property of the Piper betel phenol, allylpyrocatechol against indomethacin-induced stomach ulceration and mechanism of action. World J Gastroenterol. 2007;13:3705–3713. doi: 10.3748/wjg.v13.i27.3705. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 21.Mehrabani D, Rezaee A, Azarpira N, Fattahi MR, Amini M, Tanideh N, Panjehshahin MR, Saberi-Firouzi M. The healing effects of Teucrium polium in the repair of indomethacin-induced gastric ulcer in rats. Saudi Med J. 2009;30:494–499. [PubMed] [Google Scholar]
  • 22.Pakrashi A, Pandit S, Bandyopadhyay SK, Pakrashi SC. Antioxidant effect ofPhyllanthus emblica fruits on healing of indomethacin induced gastric ulcer in rats. Indian J Clin Biochem. 2003;18:15–21. doi: 10.1007/BF02867660. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 23.Molina V, Carbajal D, Arruzazabala L, Más R. Therapeutic effect of D-002 (abexol) on gastric ulcer induced experimentally in rats. J Med Food. 2005;8:59–62. doi: 10.1089/jmf.2005.8.59. [DOI] [PubMed] [Google Scholar]
  • 24.Hiruma-Lima CA, Santos LC, Kushima H, Pellizzon CH, Silveira GG, Vasconcelos PC, Vilegas W, Brito AR. Qualea grandiflora, a Brazilian “Cerrado” medicinal plant presents an important antiulcer activity. J Ethnopharmacol. 2006;104:207–214. doi: 10.1016/j.jep.2005.09.002. [DOI] [PubMed] [Google Scholar]
  • 25.Cheng CL, Guo JS, Luk J, Koo MW. The healing effects of Centella extract and asiaticoside on acetic acid induced gastric ulcers in rats. Life Sci. 2004;74:2237–2249. doi: 10.1016/j.lfs.2003.09.055. [DOI] [PubMed] [Google Scholar]
  • 26.Dharmani P, Kuchibhotla VK, Maurya R, Srivastava S, Sharma S, Palit G. Evaluation of anti-ulcerogenic and ulcer-healing properties of Ocimum sanctum Linn. J Ethnopharmacol. 2004;93:197–206. doi: 10.1016/j.jep.2004.02.029. [DOI] [PubMed] [Google Scholar]
  • 27.Calvo TR, Lima ZP, Silva JS, Ballesteros KV, Pellizzon CH, Hiruma-Lima CA, Tamashiro J, Brito AR, Takahira RK, Vilegas W. Constituents and antiulcer effect of Alchornea glandulosa: activation of cell proliferation in gastric mucosa during the healing process. Biol Pharm Bull. 2007;30:451–459. doi: 10.1248/bpb.30.451. [DOI] [PubMed] [Google Scholar]
  • 28.Dai XP, Li JB, Liu ZQ, Ding X, Huang CH, Zhou B. Effect of Jianweiyuyang granule on gastric ulcer recurrence and expression of VEGF mRNA in the healing process of gastric ulcer in rats. World J Gastroenterol. 2005;11:5480–5484. doi: 10.3748/wjg.v11.i35.5480. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.Ling JH, Li JB, Shen DZ, Zhou B. [Nuclear factor-kappaB mRNA and protein expression in stomach tissue of rats with gastric ulcer recurrence and effect of jianwei yuyang granule on its expression] Zhongguo Zhongxiyi Jiehe Zazhi. 2006;26:228–231. [PubMed] [Google Scholar]
  • 30.Dorababu M, Prabha T, Priyambada S, Agrawal VK, Aryya NC, Goel RK. Effect of Bacopa monniera and Azadirachta indica on gastric ulceration and healing in experimental NIDDM rats. Indian J Exp Biol. 2004;42:389–397. [PubMed] [Google Scholar]
  • 31.Ito M, Ban A, Ishihara M. Anti-ulcer effects of chitin and chitosan, healthy foods, in rats. Jpn J Pharmacol. 2000;82:218–225. doi: 10.1254/jjp.82.218. [DOI] [PubMed] [Google Scholar]
  • 32.Wang GZ, Ru X, Ding LH, Li HQ. Short term effect of Salvia miltiorrhiza in treating rat acetic acid chronic gastric ulcer and long term effect in preventing recurrence. World J Gastroenterol. 1998;4:169–170. doi: 10.3748/wjg.v4.i2.169. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 33.Gao Y, Tang W, Gao H, Chan E, Lan J, Zhou S. Ganoderma lucidum polysaccharide fractions accelerate healing of acetic acid-induced ulcers in rats. J Med Food. 2004;7:417–421. doi: 10.1089/jmf.2004.7.417. [DOI] [PubMed] [Google Scholar]
  • 34.Hamaishi K, Kojima R, Ito M. Anti-ulcer effect of tea catechin in rats. Biol Pharm Bull. 2006;29:2206–2213. doi: 10.1248/bpb.29.2206. [DOI] [PubMed] [Google Scholar]
  • 35.Jainu M, Devi CS. Antiulcerogenic and ulcer healing effects of Solanum nigrum (L.) on experimental ulcer models: possible mechanism for the inhibition of acid formation. J Ethnopharmacol. 2006;104:156–163. doi: 10.1016/j.jep.2005.08.064. [DOI] [PubMed] [Google Scholar]
  • 36.Kang JM, Kim N, Kim B, Kim JH, Lee BY, Park JH, Lee MK, Lee HS, Kim JS, Jung HC, et al. Enhancement of gastric ulcer healing and angiogenesis by cochinchina Momordica seed extract in rats. J Korean Med Sci. 2010;25:875–881. doi: 10.3346/jkms.2010.25.6.875. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 37.Li B, Shang JC, Zhou QX. [Study of total alkaloids from Rhizoma Coptis Chinensis on experimental gastric ulcers] Chin J Integr Med. 2005;11:217–221. doi: 10.1007/BF02836508. [DOI] [PubMed] [Google Scholar]
  • 38.Liang XB, Sun J, Zhao GP. [Effect of banxia xiexin decoction on leptin and endothelin-1 of gastric ulcer rat and the optimal combination screening of active components] Zhong Yao Cai. 2012;35:1637–1640. [PubMed] [Google Scholar]
  • 39.Mahattanadul S, Nakamura T, Panichayupakaranant P, Phdoongsombut N, Tungsinmunkong K, Bouking P. Comparative antiulcer effect of bisdemethoxycurcumin and curcumin in a gastric ulcer model system. Phytomedicine. 2009;16:342–351. doi: 10.1016/j.phymed.2008.12.005. [DOI] [PubMed] [Google Scholar]
  • 40.Matsumoto T, Sun XB, Hanawa T, Kodaira H, Ishii K, Yamada H. Effect of the antiulcer polysaccharide fraction from Bupleurum falcatum L. on the healing of gastric ulcer induced by acetic acid in rats. Phytother Res. 2002;16:91–93. doi: 10.1002/ptr.986. [DOI] [PubMed] [Google Scholar]
  • 41.Melese E, Asres K, Asad M, Engidawork E. Evaluation of the antipeptic ulcer activity of the leaf extract of Plantago lanceolata L. in rodents. Phytother Res. 2011;25:1174–1180. doi: 10.1002/ptr.3411. [DOI] [PubMed] [Google Scholar]
  • 42.Miller MJ, MacNaughton WK, Zhang XJ, Thompson JH, Charbonnet RM, Bobrowski P, Lao J, Trentacosti AM, Sandoval M. Treatment of gastric ulcers and diarrhea with the Amazonian herbal medicine sangre de grado. Am J Physiol Gastrointest Liver Physiol. 2000;279:G192–G200. doi: 10.1152/ajpgi.2000.279.1.G192. [DOI] [PubMed] [Google Scholar]
  • 43.Peng SL, Liu XW, Zhang ZR. [Investigation of therapeutic mechanism of Weiweifang on experimental gastric ulcer in rats viewing from metabonomics] Zhongguo Zhongxiyi Jiehe Zazhi. 2010;30:1073–1077. [PubMed] [Google Scholar]
  • 44.Pereira IT, Burci LM, da Silva LM, Baggio CH, Heller M, Micke GA, Pizzolatti MG, Marques MC, Werner MF. Antiulcer effect of bark extract of Tabebuia avellanedae: activation of cell proliferation in gastric mucosa during the healing process. Phytother Res. 2013;27:1067–1073. doi: 10.1002/ptr.4835. [DOI] [PubMed] [Google Scholar]
  • 45.Xu X, Xie B, Pan S, Liu L, Wang Y, Chen C. Effects of sea buckthorn procyanidins on healing of acetic acid-induced lesions in the rat stomach. Asia Pac J Clin Nutr. 2007;16 Suppl 1:234–238. [PubMed] [Google Scholar]
  • 46.Yang Q, Zhang Z, Zhu X, Ruan H, Fu Y. [Therapeutic effect of astaxanthin on acetic acid-induced gastric ulcer in rats] Yao Xue Xue Bao. 2009;44:558–560. [PubMed] [Google Scholar]
  • 47.Ye YN, So HL, Liu ES, Shin VY, Cho CH. Effect of polysaccharides from Angelica sinensis on gastric ulcer healing. Life Sci. 2003;72:925–932. doi: 10.1016/s0024-3205(02)02332-9. [DOI] [PubMed] [Google Scholar]
  • 48.Zheng XG, Zhang JJ, Huang YC. [Study on the effect of weitongning on epidermal growth factor and nitric oxide contents in tissue of stomach of rats with gastric ulcer] Zhongguo Zhongxiyi Jiehe Zazhi. 2004;24:549–551. [PubMed] [Google Scholar]
  • 49.Xu JJ, Huang P, Wu QH, Cao HY, Wen S, Liu J. [Study on efficacy and mechanism of weiyangning pills against experimental gastric ulcer] Zhongguo Zhongyao Zazhi. 2013;38:736–739. [PubMed] [Google Scholar]
  • 50.Mishra V, Shukla A, Pandeti S, Barthwal MK, Pandey HP, Palit G, Narender T. Arbortristoside-A and 7-O-trans-cinnamoyl-6β-hydroxyloganin isolated from Nyctanthes arbortristis possess anti-ulcerogenic and ulcer-healing properties. Phytomedicine. 2013;20:1055–1063. doi: 10.1016/j.phymed.2013.04.010. [DOI] [PubMed] [Google Scholar]
  • 51.Liu JP, Hu DJ, Zong QH, Chen Z, Niu B. [Effect of Chinese drugs for jianpi huayu on healing quality of gastric ulcer in rats] Zhongguo Zhongxiyi Jiehe Zazhi. 2004;24:635–637. [PubMed] [Google Scholar]
  • 52.Rodríguez JA, Theoduloz C, Yáñez T, Becerra J, Schmeda-Hirschmann G. Gastroprotective and ulcer healing effect of ferruginol in mice and rats: assessment of its mechanism of action using in vitro models. Life Sci. 2006;78:2503–2509. doi: 10.1016/j.lfs.2005.10.018. [DOI] [PubMed] [Google Scholar]
  • 53.Nishida K, Ohta Y, Kobayashi T, Ishiguro I. Involvement of the xanthine-xanthine oxidase system and neutrophils in the development of acute gastric mucosal lesions in rats with water immersion restraint stress. Digestion. 1997;58:340–351. doi: 10.1159/000201464. [DOI] [PubMed] [Google Scholar]
  • 54.Ohta Y, Kobayashi T, Nishida K, Nagata M, Ishiguro I. Therapeutic effect of Oren-gedoku-to extract on stress-induced acute gastric mucosal lesions in rats. Phytother Res. 1999;13:588–592. doi: 10.1002/(sici)1099-1573(199911)13:7<588::aid-ptr505>3.0.co;2-p. [DOI] [PubMed] [Google Scholar]
  • 55.Tuorkey M, Karolin K. Anti-ulcer activity of curcumin on experimental gastric ulcer in rats and its effect on oxidative stress/antioxidant, IL-6 and enzyme activities. Biomed Environ Sci. 2009;22:488–495. doi: 10.1016/S0895-3988(10)60006-2. [DOI] [PubMed] [Google Scholar]
  • 56.He LZ, Zhang Q, Wang SC. [Clinical study on treatment of gastric ulcer with qingwei zhitong pill] Zhongguo Zhongxiyi Jiehe Zazhi. 2001;21:422–423. [PubMed] [Google Scholar]
  • 57.Ge Y, Cui JC, Zhou RL. [Clinical and experimental study on separately decocted and mingly decocted jianweishu granule] Zhongguo Zhongxiyi Jiehe Zazhi. 2002;22:420–422. [PubMed] [Google Scholar]
  • 58.Wei BH. [Clinical and experimental study on the prescription of jianpi yipi] Zhongxiyi Jiehe Zazhi. 1989;9:537–59, 516. [PubMed] [Google Scholar]
  • 59.Pang NH. [The nature of “cold” and “heat” syndromes and therapeutic effects in traditional Chinese medicine on peptic ulcer] Zhongxiyi Jiehe Zazhi. 1987;7:652–64, 643. [PubMed] [Google Scholar]
  • 60.Lin Y, Liao SS, Zhou YJ. [Clinical study on effect of Jianwei Yuyang Granule in treating patients with gastric ulcer] Zhongguo Zhongxiyi Jiehe Zazhi. 2007;27:606–609. [PubMed] [Google Scholar]
  • 61.Wan QX, Wang Y, Wang D. [Clinical and experimental studies of yuyang powder in treatment of peptic ulcer] Zhongguo Zhongxiyi Jiehe Zazhi. 1996;16:78–80. [PubMed] [Google Scholar]
  • 62.Yang Y, Yu KY, Zeng XC. [Clinical study on treatment of peptic ulcer with bushen kangkui decoction] Zhongguo Zhongxiyi Jiehe Zazhi. 1995;15:583–585. [PubMed] [Google Scholar]
  • 63.Zhou FS, Hu LJ, Wang RJ, Huang ZX, Luo Q. Study on clinical effect and mechanism of jianpi qingre huayu recipe. Chin J Integr Med. 2007;13:22–26. doi: 10.1007/s11655-007-0022-z. [DOI] [PubMed] [Google Scholar]
  • 64.Zhou G. Treatment of peptic ulcer with xiao jianzhong tang--a report of 80 cases. J Tradit Chin Med. 2005;25:23–24. [PubMed] [Google Scholar]
  • 65.Wang CH, Wang YH, Zhou Y. [Clinical and experimental study on effect of Chinese herbal drugs on producing prostaglandin in gastric mucosa] Zhongguo Zhongxiyi Jiehe Zazhi. 1994;14:528–530. [PubMed] [Google Scholar]
  • 66.Zhou B, Li JB, Cai GX, Ling JH, Dai XP. [Therapeutic effects of the combination of traditional Chinese medicine and western medicine on patients with peptic ulcers] Zhongnan Daxue Xuebao Yixueban. 2005;30:714–718. [PubMed] [Google Scholar]
  • 67.Deng C, Luo WS, Li GX. [Morphological observation on gastric mucosa membrane of patients with gastric ulcer treated with combined use of Qifang Weitong Powder and omeprazole] Zhongguo Zhongxiyi Jiehe Zazhi. 2007;27:610–612. [PubMed] [Google Scholar]
  • 68.“Wenweishu/yangweishu in the Treatment of Helicobacter pylori Positive Patients with Chronic Gastritis and Peptic Ulcer” Study Group, Hu FL. A multicenter study of Chinese patent medicine wenweishu/yangweishu in the treatment of Helicobacter pylori positive patients with chronic gastritis and peptic ulcer. Zhonghua Yixue Zazhi. 2010;90:75–78. [PubMed] [Google Scholar]
  • 69.Li JB, Jin YQ. [Treatment of peptic ulcer with jian-wei yu-wang tablets] Zhongxiyi Jiehe Zazhi. 1991;11:141–13, 141-13. [PubMed] [Google Scholar]
  • 70.Zhang WP, Ge HN, Guo JW. Effect of yiqi huoxue formula on healing quality and recurrence rate of peptic ulcer. Zhongguo Zhongxiyi Jiehe Zazhi. 2009;29:1081–1084. [PubMed] [Google Scholar]
  • 71.Chen XW, Sneed KB, Pan SY, Cao C, Kanwar JR, Chew H, Zhou SF. Herb-drug interactions and mechanistic and clinical considerations. Curr Drug Metab. 2012;13:640–651. doi: 10.2174/1389200211209050640. [DOI] [PubMed] [Google Scholar]
  • 72.Remirez D, Avila Pérez J, Jiménez López G, Jacobo OL, O’Brien PJ. Interactions between herbal remedies and medicinal drugs--considerations about Cuba. Drug Metabol Drug Interact. 2009;24:183–194. doi: 10.1515/dmdi.2009.24.2-4.183. [DOI] [PubMed] [Google Scholar]
  • 73.Movahedian A, Asgary S, Mansoorkhani HS, Keshvari M. Hepatotoxicity effect of some Iranian medicinal herbal formulation on rats. Adv Biomed Res. 2014;3:12. doi: 10.4103/2277-9175.124641. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 74.Niggemann B, Grüber C. Side-effects of complementary and alternative medicine. Allergy. 2003;58:707–716. doi: 10.1034/j.1398-9995.2003.00219.x. [DOI] [PubMed] [Google Scholar]
  • 75.Banerjee D, Maity B, Bauri AK, Bandyopadhyay SK, Chattopadhyay S. Gastroprotective properties of Myristica malabarica against indometacin-induced stomach ulceration: a mechanistic exploration. J Pharm Pharmacol. 2007;59:1555–1565. doi: 10.1211/jpp.59.11.0014. [DOI] [PubMed] [Google Scholar]
  • 76.Repetto MG, Llesuy SF. Antioxidant properties of natural compounds used in popular medicine for gastric ulcers. Braz J Med Biol Res. 2002;35:523–534. doi: 10.1590/s0100-879x2002000500003. [DOI] [PubMed] [Google Scholar]
  • 77.Kang C, Li J, Dai X. Effect of Jianwei Yuyang granule on gastric ulcer of rats and nitride oxide in gastric mucous membrane. Zhongguo Zhongxiyi Jiehe Xiaohua Zazhi. 2005;13:4–6. [Google Scholar]
  • 78.Tao X, Li G, Luo S, Yi P. Mechanism of prescription of strengthening spleen and replenishing Qi on promoting renovation of stomach mucosa. Zhongguo Zhongxiyi Jiehe Xiaohua Zazhi. 2005;13:387–389. [Google Scholar]
  • 79.Feldman M. Suppression of acid secretion in peptic ulcer disease. J Clin Gastroenterol. 1995;20 Suppl 1:S1–S6. doi: 10.1097/00004836-199506001-00002. [DOI] [PubMed] [Google Scholar]
  • 80.Malfertheiner P. The intriguing relationship of Helicobacter pylori infection and acid secretion in peptic ulcer disease and gastric cancer. Dig Dis. 2011;29:459–464. doi: 10.1159/000332213. [DOI] [PubMed] [Google Scholar]
  • 81.Mullane KM, Kraemer R, Smith B. Myeloperoxidase activity as a quantitative assessment of neutrophil infiltration into ischemic myocardium. J Pharmacol Methods. 1985;14:157–167. doi: 10.1016/0160-5402(85)90029-4. [DOI] [PubMed] [Google Scholar]
  • 82.Matsuo Y, Onodera H, Shiga Y, Nakamura M, Ninomiya M, Kihara T, Kogure K. Correlation between myeloperoxidase-quantified neutrophil accumulation and ischemic brain injury in the rat. Effects of neutrophil depletion. Stroke. 1994;25:1469–1475. doi: 10.1161/01.str.25.7.1469. [DOI] [PubMed] [Google Scholar]
  • 83.Venables CW. Mucus, pepsin, and peptic ulcer. Gut. 1986;27:233–238. doi: 10.1136/gut.27.3.233. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 84.Allen A, Flemström G. Gastroduodenal mucus bicarbonate barrier: protection against acid and pepsin. Am J Physiol Cell Physiol. 2005;288:C1–19. doi: 10.1152/ajpcell.00102.2004. [DOI] [PubMed] [Google Scholar]
  • 85.Allen A, Pearson JP, Blackburn A, Coan RM, Hutton DA, Mall AS. Pepsins and the mucus barrier in peptic ulcer disease. Scand J Gastroenterol Suppl. 1988;146:50–57. doi: 10.3109/00365528809099130. [DOI] [PubMed] [Google Scholar]
  • 86.Xie JH, Chen YL, Wu QH, Wu J, Su JY, Cao HY, Li YC, Li YS, Liao JB, Lai XP, et al. Gastroprotective and anti-Helicobacter pylori potential of herbal formula HZJW: safety and efficacy assessment. BMC Complement Altern Med. 2013;13:119. doi: 10.1186/1472-6882-13-119. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from World Journal of Gastroenterology : WJG are provided here courtesy of Baishideng Publishing Group Inc

RESOURCES