Quality of healing of gastric ulcers: Natural products beyond acid suppression

Abstract

Gastric ulcer is a chronic disease featured with unexpected complications, including bleeding, stenosis and perforation, as well as a high incidence of recurrence. Clinical treatments for gastric ulcer have allowed the rapid development of potent anti-ulcer drugs during the last several decades. Gastric ulcer healing is successful with conventional treatments including H2-receptor antagonists, and proton pump inhibitors (PPIs) have been essential for ulcer healing and prevention of complications. Additionally, Helicobacter pylori eradication therapy is effective in reducing ulcer recurrence and leads to physiological changes in the gastric mucosa which affect the ulcer healing process. However, in spite of these advancements, some patients have suffered from recurrence or intractability in spite of continuous anti-ulcer therapy. A new concept of the quality of ulcer healing (QOUH) was initiated that considers the reconstruction of the mucosal structure and its function for preventing ulcer recurrence. Although several gastroprotection provided these achievements of the QOUH, which PPI or other acid suppressants did not accomplish, we found that gastroprotection that originated from natural products, such as a newer formulation from either Artemisia or S-allyl cysteine from garlic, were very effective in the QOUH, as well as improving clinical symptoms with fewer side effects. In this review, we will introduce the importance of the QOUH in ulcer healing and the achievements from natural products.

Keywords: Acid suppression; Artemisia isopropanol extract; Gastric ulcers; Natural products; Quality of ulcer healing; S-allyl cysteine.

Figure 1

Schematic representation of intracellular pathway on ulcer healing mechanism. SAC: Artemisia or S-allyl cysteine; PPI: Proton pump inhibitor; NSAIDs: Nonsteroidal anti-inflammatory drugs; TNF-α: Tumor necrosis factor-α; MCP-1: Monocyte chemotactic protein-1; EGF: Epidermal growth factor; HGF: Hepatocyte growth factor; VEGF: Vascular endothelial growth factor; IL-1β: Interleukin-1β; IGF-1: Insulin like growth factor-1.

Figure 2

Gross features of gastric ulcer stage assessed at 4 wk after acetic acid serosa injection according to group. SAC: Artemisia or S-allyl cysteine; PPI: Proton pump inhibitor.