Medicinal plants used for treatment gastric disorders according to native population of different areas around the world. The names of the species are given according to the regional language: (Q)
1. Introduction
The signs and symptoms of gastritis depend on how long the problem has existed. If it occurs suddenly is called
Clinicians differ on classification of the less common and specific forms of gastritis, particularly since there are so much overlap with
A recent advance in the histopathology of gastritis is the replacement of the traditional definition of gastric atrophy, “loss of glands”, with the new definition of gastric atrophy as the “loss of appropriate glands”. By this definition, intestinalized glands represent atrophy when the metaplastic change involves the entire length of the original glandular unit and is considered as metaplastic atrophy. The application of the new definition has resulted in a high level of agreement among gastrointestinal pathologists trained in different cultural contexts. As there is obvious evidence that the severity and the extent of gastric atrophy relate to different risk levels of gastric cancer, an international group of gastroenterologists and pathologists,
Nowadays, one of the most important cases of gastritis is the infection by
Among the most conventional drugs employed, PPIs such as omeprazole (OPZ) and its derivates are the most common although most of these drugs produce undesirable side effects and drug interactions (Pali-Schöll et. al., 2010, 2011). OPZ is available over-the-counter and in inexpensive generic formulations. It is promoted as a therapy for a range of disease states, from mild heartburn to aggressive
Anti-ulcer drugs are useful co-medications to protect the gastric mucosa from damage due to steroidal and non-steroidal drugs. This is especially relevant during long-term pain and anti-inflammatory therapies, e.g. in management of rheumatoid arthritis or inflammatory bowel disease. Inhibition or neutralization of gastric acid with so-called anti-ulcer drugs is necessary to treat gastritis and peptic ulcers, e.g. drugs such as PPIs, histamine type-2 receptor antagonist, sucralfate, or acid neutralizers like bismuth compounds (co-prescribed to protect the gastric mucosa). The therapy goal is to reach gastric pH levels above 4.5 (Julapalli & Graham, 2005) also for children (Tofil et. al., 2008) or even above 6.0 for treating bleeding peptic ulcers (Pali-Schöll et. al., 2010). Avoidance of acid is needed to stop autodigestive processes and support mucosal healing in the extreme environment of the gastric lumen.
The success rate of conventional eradication of triple therapy is
2. Phytotherapy on gastric diseases
Plant derivates had been employed by population to prevent different kind of diseases for centuries. The knowledge of plant properties was acquired by ancient civilization that passed down from generation to generation until today and it is known as “popular medicine or traditional medicine” (Al-Qura´n, 2009). The number of plants species around the world is infinite and medicinal plants are used to treat different kind of pathologies like infection, internal and external inflammatory process, dermatological, urinary/genital, parasitosis, hemorrhoids, blood pressure, diabetic problems, etc., although the main usage is against gastrointestinal and respiratory problems (Al-Qura´n, 2009; De la Cruz et. al., 2007; Neves et. al., 2009; Rehecho et. al., 2010). The principal way of administration is like beverages, infusion or decoction of different parts of the plants (root, stem, seed, rhizome, bark, leaf, flowers, fruit or mixtures).
The surveys of popular medicine are useful to understanding the application of different plant species, the way of usage, administration and mainly their properties. In some cases, this kind of beverages could be effective against gastric mucosal inflammation (active chronic gastritis, erosive or not) and also against
Beverages are known in different cultures as “tea”. The
Country/ region | |||||||
Acanthaceae | Chuncho-chuncho (Q) | Leaves | Infusion | Stomachache | Perú (Canta, Lima) | De la Cruz et. al., 2007 | |
Asteraceae | - | Leaves | Infusion/ Decoction | Purgative, gastric ulcers, wound healing | West Africa, Asia and South America | Shirwaikar et. al., 2003 | |
Caroelina (I) | Roots | Decoction | Stomachache | Italy (Valvestino) | Vitalini et. al., 2009 | ||
Chinche (S) | Leaves | Decoction | Stomachache, intestinal pain, digestive | Perú (Canta, Lima) | De la Cruz et. al., 2007 | ||
Anis Serrano (S) | Aerial parts | Decoction | Stomachache, intestinal pain | Perú (Ancash) | Hammond et. al., 1998 | ||
- | Roots | Decoction, cold macerate | Gastrointestinal disorders, gastritis and gastroduodenal ulcers | Mali | Nergard et. al., 2004 | ||
Brassicaceae | Koza (ET) | Leaves | - | Gastritis | Ethiopia (Sheko) | Giday et. al., 2010 | |
- | Seeds | - | Stomachache | Ethiopia (Sheko) | Giday et. al., 2010 | ||
Celastraceae | Espinheira santa (P) | Leaves | Infusion | Contraceptive, abortifacient, emenagogue, stomach disorders | Argentina, Brazil, Paraguay | Hatsuko Baggio et. al., 2007 | |
Compositae | Mifoil (E) | Aerial parts | Infusion | Stomachache | Jordan (Showbak) | Al-Qura’n et. al., 2009 | |
Sacaca (P) | Leaves barks | Infusion | Antiulcerogenic, gastrointestinal disorders | Brazil | Hiruma-Lima et. .al., 2000 | ||
Euphorbiaceae | Yagua rova (G) | Rhi-zome | Infusion/ Decoction | Gastroprotective | Paraguay, Argentina | Pertino et. al., 2007 | |
Geraniaceae | Erva de S. Roberto, Bico de pinga amor (P) | Aerial parts, roots | - | Stomach acidity and stomachache, cancer treatment, uterus inflammation | Portugal (Trás-os-Montes) | Neves et. al., 2009 | |
Umckaloabo (A) | Roots | - | Antimicrobial effects | Southern Africa | Wittschier et. al., 2007 | ||
Geranio (S) | Leaves | Infusion/ decoction | Digestive, carminative, gastritis, amigdalitis, hemorrhagias of the gastro-intestinal tube, others | Perú (Nor-Yauyos) | Elmann et. al. 2010; Rehecho et. al., 2010 | ||
Krameriaceae | Ratanya or Ratiñay (Q) | Roots, stems | Decoction | Diarrhea, inflammation, treatment of stomach cancer | Perú (Ancash) | Hammond et. al., 1998; De la Cruz et. al., 2007 | |
Lamiaceae Lamiaceae | Malvela, redondinha (P) | Aerial parts | - | Cough, stomach pain, gastritis and acidity, diarrhoea, renal problems, others | Portugal (Trás-os-Montes) | Neves et. al., 2009 | |
Cidreira (P) | Aerial parts | - | Intestinal gases and pain, digestion and bile stimulation, stomachache and gastritis, others. | Portugal (Trás-os-Montes) | Neves et. al., 2009 | ||
Hortelão, Piperita, Pimenta (P); Menta (S) | Green leaves | Infusion | Digestive and antiflatulence to relieve gastritis, dyspepsia and biliar disorders, analgesic, rheuma, others | Portugal (Trás-os-Montes); Perú (Nor-Yauyos) | Neves et. al., 2009; Rehecho et. al., 2010 | ||
Muña (S) | Leaves | Infusion | Digestive, carminative, emolient ,diuretic, to treat diarrhea, gastritis and colics, others | Perú (Nor-Yauyos) | Rehecho et. al., 2010; Schmidt-Lebuhn, 2008; De la Cruz et. al., 2007 | ||
Mala mujer (S) | Leaves, stems | Infusion | Stomachache | Perú (Canta, Lima) | De la Cruz et. al., 2007 | ||
Olomora (A) | Leaves | Oil | Gastric ulcers, anti-cathartic, fever, stomachache | Tropical Asia ; west and east Africa | Tan et. al., 2002 | ||
Fabaceae | Liquorice (E) | Roots | Syrup | Diuretic, gastric ulcer, expectorant | Mediterranean region, Asia Minor and Middle East | Al-Qura’n et. al., 2009; Wittschier et. al., 2009 | |
Malvaceae | Rose mallow (E); Alteia (P) | Aerial parts, roots | Infusion | Abdominal inflammation, cough, colitis and gastritis, pleura infection, dental growth and development, others | Jordan (Showbak); Portugal (Trás-os-Montes) | Al-Qura’n et. al., 2009; Neves et. al., 2009 | |
Okra | Fruits | Fresh fruits | Cholesterol reduction hypoglycemic, gastric irritation | Africa, Asia and America | Lengsfeld et. al., 2004 | ||
Papaveraceae | Poppy(E) | Leaves, stems | Decoction | Antidysenteric, antispasmodic | Jordan (Showbak) | Al-Qura’n et. al., 2009; | |
Piperaceae | Congona (Q) | Aerial parts | Crushed/ Juice | Wounds healing, juice is swallowed to treat gastric ulcers | Perú (Ancash) | Hammond et al., 1998 | |
Poaceae | Grama (P) | Dried roots | - | Diuretic, depurative, gastric inflammation | Portugal (Trás-os-Montes) | Neves et. al., 2009 | |
Polygalaceae | Barba-de-são-joão,vassourinha branca or mimosa (P) | Aerial parts | - | Gastrprotector , asthma, bonchitis, stomach pain, diarrhea, anti-inflammatory, anti-spasmodic | Brazilian Atlantic coast | Rocha Lapa et. al., 2007 | |
Punicaceae | Pomegranate (E) | Fruits | Fresh fruits | Ulcer, hepatic damage, tonic fever, heart and gastric diseases, others | Europe, Indo-China, South Africa | Ajaikumar et. al., 2005 | |
Rosaceae | Thorny burnet (E) | Roots, fruits | Soaking | Renal calculi, antidiabetic, gastric diseases | Jordan (Showbak) | Al-Qura’n et. al., 2009; | |
Scrophulariaceae | Zapatito or globo-globo (S) | Leaves, flowers | Infusion | Stomachache | Perú (Canta, Lima) | De la Cruz et. al., 2007 | |
Globo-globo (S) | Leaves, flowers | Infusion | Stomachache | Perú (Canta, Lima) | De la Cruz et. al., 2007 | ||
Solanaceae | Handbane (E) | Aerial parts | Decoction | Narcotic, hypnotic, stomachache | Jordan (Showbak) | Al-Qura’n et. al., 2009 | |
Verbenaceae | - | Aerial parts | Hydro-alcoholic tincture | Wounds, mycoses, stomachache | Northeast Brazil | Barros Monteiro et. al., 2007 | |
Incayuyo (S) | Aerial parts | Infusion/ Decoction | Dyspepsia, diuretic, cough treatment, indigestion, stomachache | Central and Northwest Argentina | Gorzalczany et. al., 2008 | ||
Vochyslaceae | Pau-tucano or pau-doce (P) | Leaves, barks | Infusion | Stomach inflammation, asthma, pulmonary congestion | South America | Camargo Gomes et al., 2009 | |
Zingiberaceae | Heel kalan, Bari ilaichi (I) | Fruits | Infusion | Stomacheache, digestive, anti-emetic, carminative | India | Jafri et al., 2001 |
2.1. Effects of phenolic compounds of medicinal plants on gastritis
Gastritis troubles led to researchers to study the gastric mucosa in different animal model (rat, mouse, pig, rabbit, among others) where mucosal damage was induced by either chemical compounds (aspirin, HCl, ethanol, acetic acid, ibuprofen and more), stress (hypothermia), pylorus ligation or by microbiological agents (
Flavonoids are phenolic compounds widely distributed in a wide variety of edible plants including leafy vegetables, fruits (strawbery, apple, etc.) and beverages (tea, red wine, beer, etc.). They have been reported to exert multiple biological effects, including antiviral, antithrombotic, anti-ischemic, anti-inflammatory, antihistaminic, antioxidant and free-radical scavenging abilities (Kahraman et. al., 2003). The phenolic compounds, widely distributed in plants, are the major compounds associated to human health and beneficial effects on gastritis, ulcer and cancer. The gastroprotective effect seems to be related to increase in endogenous PG, reduction in histamine secretion, scavenging oxygen-derived free radicals and even to gastric mucus stimulation (Rocha Lapa et. al., 2007; Tan et. al., 2002). The importance of such effects is to assure the gastric mucosal integrity by a dynamic balance and homeostasis between epithelial cell renewal and cellular apoptosis. In normal mammalian stomach, gastric mucosal cells have a rapid rate of turnover, being entirely replaced within 3–5 days as the result of rapid proliferation of progenitor cells at the isthmus and rapid cell death at the gastric surface (Park et. al., 2004).
However, treatment of gastric trouble with phenolic compounds is not always beneficial to gastritis condition. On one hand, the main effect is associated to anti-inflammatory response due to PG and NO inhibition; on the other hand, PG is responsible for the integrity of gastric mucosa through activation of a cascade of mechanisms that include inhibition of gastric acid secretion, stimulation of mucus-bicarbonate secretion and apoptosis, as well as modulation of the blood flow (Atay et. al., 2000) while NO is also involved in regulation of gastric motility, mucus and acid secretion (Uchida et. al., 2001).
Different medicinal plants gave good results in gastric trouble treatments, effects that were related to the anti-inflammatory and antioxidant activity of phenolic compounds. As an example, the ethanol extract of
Quercetin is a common flavonoid distributed in a broad variety of vegetables, fruits and beverages as tea, red wine, beer, etc. It is known for its vasoactive properties but it also prevented gastric mucosal ulcers induced in rats by the administration of ethanol. The flavonoid prevented the increase of MPO activity (associated to this experimental model) thus protecting gastric mucosa from the deleterious effects of activated neutrophil infiltration (Kahraman et. al., 2003). Besides, its antioxidant property may reduce the lipid peroxidation and protein carbonyl compounds, increasing the superoxide dismutase activity which may play a role on gastric inflammation (Coskun et. al., 2004; Kahraman et. al., 2003, as cited in Serrano et. al., 1999). A novel natural product isolated from the
Besides phenolic compounds, terpenes from essential oil (EO) were also tested with outstanding results. Solidagenone is a labdane diterpene synthesized in rhizomes of
OPZ is an effective inhibitor of leukocyte infiltration, over-expression of adhesion molecules, IL-1a, and TNF- production. When rats received OPZ, the lipid-peroxidation (expressed in terms of malondialdehyde and NO) decreased and pepsinogen secretion is stimulated, so its therapeutic effect could be related to its antioxidant property. On the other hand, authors compare the OPZ with natural compounds as curcuminoids; curcuminoids are isolated from dried roots of turmeric (
2.2. Effectiveness of plants glycoside derivate compounds on H. pylori infection
Phenolic compounds as flavonoids and their derivates have also antimicrobial effects as it was demonstrated in cases of H.
It has been suggested that the best way to prevent
Adhesion to epithelial cells has been recognized as an essential step of the infectious process for virtually all bacterial pathogens and therefore many efforts are aimed to develop anti-adhesion therapy. Sialyllactose (NeuAc[K2-3]Gal[L1-4]Glc), an inhibitor of the sialic acid-specifc adhesin of
These beneficial effects lead us to conclude that natural inhibitors of bacterial growth and inflammation may offer alternatives to antibiotic therapy for bacterial eradication and may be used as supplements to conventional eradication therapy in populations at high risk for gastric cancer (Stoicov et. al., 2009).
3. Lactic acid bacteria in gastritis
Lactic acid bacteria (LAB) are a group of
Probiotic foods containing LAB have been proposed as a natural alternative to improve the general health status, preventing various gastrointestinal disorders such as gastric ulcers and inflammation related to
Different LAB species were tested in gastritis models mainly in treatment of
The inclusion of probiotics in a conventional therapy (triple therapy: antibiotics and PPI) for
The effect of LAB on acute gastric lesions induced by chemical agents in experimental models was also reported. The administration of probiotic lactobacilli as
Researchs on the functional properties of metabolites produced in food by LAB during fermentation such as exopolysaccharides (EPS) increased in recent years by assigning to biopolymers potential beneficial effects on human health. These effects include prebiotic effects (Dal Bello et. al., 2001; Korakli et. al., 2002; Salazar et. al., 2009), hypocholesterolemic effect (Pigeon et. al., 2002) and immunomodulatory and anti-tumor activity (Chabot et. al., 2001; Kitazawa et. al., 1998;) as well as other immune functions such as proliferation of T-lymphocytes (Forsén et. al., 1987), activation of macrophages and induction of cytokine production (Kitazawa et. al., 1991, 1996). The EPS could remain attached to the cell wall (capsular EPS) or be excreted into the environment in the form of slime or ropy EPS and its structure may vary depending, mainly, on the strain (van Hijum et. al., 2006). LABs produce two different kinds of EPS by using distinct biosynthetic pathways. The homo-polysaccharide (HoPS) are synthesized by extracellular glycansucrases and contain only one type of sugar (generally glucose) and the hetero-polysaccharide (HePS) that are assembled by cell wall-bound glycosyl-transferases from intracellular sugar nucleotide precursors, which may be constituted by 3 to 8 different monosaccharides (de Vuyst et. al., 2001). There are many EPS-producing LABs, e.g.,
It is known that the EPS of LAB have many functional properties; they have effect on the mucosal immune system, could avoid the
Rodríguez et al. (2009, 2010) reported the first evidences on the beneficial effects of both the EPS-producing LAB strains and the biopolymer on gastritis experimental animal models using acetyl salicylic acid (ASA) as gastritis inductor. Authors demonstrated the gastroprotector effect of fermented milk with the EPS-producing strain
The fermented milk with
The fermented milk FM-1190 and the EPS-1190 were able to modulate the gastric inflammatory response at the immune system level (decrease in the number of cells producing pro-inflammatory cytokines, INF- and TNF-, and increase in the number of cells producing regulatory cytokines, such as IL-10). These promising results, however, can not be ascribed to all EPS-producing LABs because of the complexity of the phenomenon. The fermented milk with the strain
Studies of scanning electronic microscopy (SEM) confirmed a greater secretion of gastric mucus after oral administration of FM-1190; they also put in evidence the presence of the strain CRL 1190 in the stomach at least 15 days after finishing the administration of the fermented milk. These confirmed previous reports concerning the ability of
Several studies reported that high molecular mass-polysaccharides of different sources (herbs, marine microalgae and fungi) have anti-ulcer, anti-inflammatory or inmuno-stimulatory effects related to anti-secretory activity of acid and pepsin, inmuno-stimulation, stimulation of gastric mucus, increase in gastric prostaglandin levels and partially suppression of TNF- genes (Gao et. al., 2002, 2004; Yamada, 1995; Yim et. al., 2005). However, the beneficial effects can not be only attributed to the size of the polymer. The different effect obtained with the strains CRL 1190, CRL 804 and CRL 638 evinced that the phenomenon is strongly strain-dependent and complex.
Whey proteins as -lactalbumin would also have gastroprotector effect (Matsumoto et. al., 2001; Rosaneli et. al., 2004; Ushida et. al., 2003, 2007); so, the interaction of EPS-producing LAB or the EPS with milk proteins may be a key factor in gastroprotection. Studies on the interaction between EPS and milk proteins is complex since EPS are gradually produced during fermentation, and the characteristics of the proteins such as charge and hydrophobicity may change during fermentation and consequently the interaction between them. The EPSs bind water and increase the moisture in the non-fat portion, interfere with protein-protein interactions reducing the rigidity of the protein network, and increase the viscosity of the serum phase (Hassan, 2008). Similar research was carried out by Ayala-Hernandez et. al. (2008) who studied the interaction between milk proteins and the EPS produced by
Considering these statements, it is assumed that in fermented milks, e.g., FM-1190, the LAB strains and the EPS together with the milk and whey proteins perform a stable three-dimensional complex network, which is attached to the gastric mucosa preferably to the mucus layer, when it is administered to animals. Thus, the EPS could interact with the mucosal tissue exerting an inmunomodulador effect, thus avoiding inflammation and or making the mucus barrier stronger, which could also affect
4. Conclusion
Gastritis is the most common illness associated to the stomach, and it is the beginning of different complication that led to ulcers and, in the worst case, gastric cancer. The disease is due to different causes as an imbalanced diet, intake of aggressive agents, or stress process (related to neurological condition) which is very common nowadays due to the population rhythm of life. However, the most aggressive case is due to
Medicinal plants and their effect in different kind of diseases, on the basis of ancient knowledge and supported by scientific evidences, emerge as an alternative therapy to cure or prevent gastric disorders. The beneficial effects are mainly related to anti-inflammatory activity and the ability to maintain a balance in the mucus barrier and mucosal renovation. Phenolic compounds, polysaccharides and derivates in different combinations are mainly involved in gastric protection, effect associated in some cases to modulation of the immune system (cytokine regulation) and mucus stimulation.
Probiotic lactic acid bacteria and probiotic foods, which beneficial effects on the gut health are strongly supported by scientific evidences, also appear as a novel and promising bio-alternative for gastritis treatment. Recent evidences indicate that some exopolysaccharide (EPS)-producing lactic acid bacteria are able to regulate and to revert the gastritis process prompted by NSAIDs, a property that is mainly related to the EPS produced by specific strains. The biopolymers could also interact with
Considering the beneficial effects of these bio-treatments in gastritis processes, it would be advisable to include them as adjunct in conventional treatments programs to reduce the side effect derived from the intake of drugs during long periods.
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