Sabira Sultana et al. Int. Res. J. Pharm. 2014, 5 (5) Page 353 INTERNATIONAL RESEARCH JOURNAL OF PHARMACY www.irjponline.com ISSN 2230 – 8407 Review Article COMPLEMENTARY AND ALTERNATIVE APPROACHES TO TREAT PEPTIC ULCER Sabira Sultana 1 *, Muhammad Akram 2 , Hafiz Muhammad Asif 2 , Naveed Akhtar 1 1 University College of Conventional Medicine, Faculty of Pharmacy and Alternative Medicine, The Islamia University of Bahawalpur, Pakistan 2 Department of Eastern Medicine and Surgery, Faculty of Medical and Health Sciences, The University of Poonch, Rawalakot, AJ and K, Pakistan *Corresponding Author Email: drsabirachishti12@gmail.com Article Received on: 19/03/14 Revised on: 11/04/14 Approved for publication: 03/05/14 DOI: 10.7897/2230-8407.050574 ABSTRACT Peptic ulcer is considered as one of the most common disorder among gastrointestinal ailments all over the world which is mainly caused by Helicobacter pylori infection, abundant use of NSAIDs, excessive alcohol intake and stress etc. Treatment of peptic ulcer with synthetic drugs such as proton pump inhibitors, H2 receptor antagonists and other non-steroidal anti-inflammatory drugs reported to have adverse effects, relapses and drug interactions. Medicinal plants containing active phyto-constituents have been proven as useful source in the prevention and treatment of various diseases including gastrointestinal problems. Demands of herbal medicines are increasing in both developed and developing countries due to growing recognition of natural plants having lesser or no side effects, relatively less toxic, economical and easily available in surrounding place. Therefore, medicinal plants stand out as being exceptional for its ethnic, ethno botanical and ethno pharmaceutical uses. In this review an attempt has been made to compile some plants which may be used in treatment or prevention of peptic ulcers. This article summarizes the antacid, anti-ulcer and gastro protective properties of the most commonly available medicinal plants. Keywords: Peptic ulcer, medicinal plants, therapeutic effects INTRODUCTION Peptic ulcer is one of the most common disorders of the gastrointestinal system, which causes discomfort to the patients, disrupting their daily routines and causes mental distress 1 . It is defined as a break off in the continuity of the stomach mucosa or duodenum as a consequence of some factors such as non-steroidal anti-inflammatory drugs (NSAIDs), gastric acids and pepsin which finally causes lesions in intestinal mucosa 2 . Several reports indicated that old age group patients are more prone to develop gastric ulcer while younger individuals have higher risk of duodenal ulcers 3,4 . Numerous factors such as complex imbalance between gastric offensive factors like acid, pepsin secretion, Helicobacter pylori (H. pylori), bile salts, some medications like NSAIDs, lipid per oxidation, ethanol, nitric oxide (NO) and defensive mucosal factors like prostaglandins, gastric mucus, blood flow, mucosal cell shedding, cellular renovation, glycoproteins, mucin secretion, proliferation and antioxidant enzymes like catalase (CAT), superoxide dismutase (SOD) and glutathione level involves in the pathogenesis of ulcer. Several other factors are also responsible for progression of peptic ulcers like tumor necrosis factor-α (TNF α), reactive oxygen species (ROS), release of histamine, incidence of apoptosis and bile acids secretion 5,6 . Synthetic drugs such as proton pump inhibitors, H 2 receptors, cytoprotectants, demulcents, anti-cholinergics and antacids are used for the treatment of peptic ulcer but these drugs produce several side effects in the body 5 . Proton pump inhibitors (Omeprazole, Lansoprazole) may cause abdominal pain, nausea, constipation, diarrhea and H 2 receptor antagonists (Cimetidine) may cause loss of libido and gynaecomastia. Due to the adverse/side effects by the use of these synthetic drugs, people prefer medicinal plants for the treatment of diseases because herbal medicines are considered safe for the treatment of peptic ulcers with lesser adverse effects, relatively less toxic, economical and effective, extensive research is carried out on medicinal plants to search potent antiulcer agents 6,7 . About 70 % of patients with peptic ulcer disease are infected by bacterium Helicobacter pylori. This organism destructs the protective coating of the stomach and duodenum and allows the digestive juices to irritate the sensitive lining below 8,9 . Non- steroidal anti-inflammatory drugs (NSAIDs) which include aspirin, ibuprofen, naproxen, piroxicam, fenoprofen, indomethacin, diclofenac, tolmetin, oxaprozin, ketoprofen, sulindac, nabumetone, etodolac, and salsalate are acidic and are the most common cause of ulcer. They block prostaglandins in the stomach, which help maintain blood flow and protect it from injury. People suffering with Zollinger-Ellison syndrome have tumors in the pancreas and duodenum that produce gastrin, a hormone that stimulates gastric acid production which leads to ulcer production. Other causes of ulcers are those factors that may direct damage the wall of the stomach or duodenum, such as heavy use of alcohol, radiation therapy, burns, and physical injury. Abdominal pain is the most common symptom of a peptic ulcer. The pain is aggravated by stomach acid coming in contact with the ulcerated area. The pain typically may be felt anywhere around the abdomen, last from a few minutes to several hours, aggravated at empty stomach, sometime temporarily relieved by eating certain foods that buffer stomach acid or by taking an acid-reducing medication, disappear and then return for a few days or weeks. Less often, ulcers may cause severe signs or symptoms such as, vomiting of blood, which may appear red or black, dark blood in stools nausea, unexplained weight loss, appetite changes 10,11 . Genetic factors may predispose to the development of ulcer, increasing age, chronic pain from any cause such as fibromyalgia, arthritis, repetitive stress injuries (like carpal tunnel syndrome), or persistent back pain, leading to