DGL licorice provides health benefits for gastrointestinal ulcers and inflammation
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Peer-reviewed literature and reference materials indicate that Deglycyrrhizinated licorice (DGL) is traditionally and clinically used for gastrointestinal ulcerative conditions such as peptic ulcers, and that licorice preparations exhibit anti-inflammatory effects that support gastrointestinal health.
Peptic ulcer disease remains a prevalent gastrointestinal disorder worldwide. Current treatments often have limitations, sparking interest in alternative therapies from medicinal plants. This review examines the gastroprotective potential of 54 North African medicinal plants against peptic ulcers. An extensive literature search was conducted, focusing on plants with preclinical and clinical evidence of anti-ulcer efficacy and documented use in North African traditional medicine. The review identified several promising plant species, such as licorice (<i>Glycyrrhiza glabra</i>), chamomile (<i>Matricaria chamomilla</i>), olive (<i>Olea europaea</i>), pomegranate (<i>Punica granatum</i>), Aloe vera, and black seed (<i>Nigella sativa</i>), along with their bioactive constituents, including flavonoids, tannins, and terpenoids. These compounds exhibit gastroprotective properties through multiple mechanisms, such as enhancing the gastric mucosal barrier, inhibiting acid secretion, displaying antioxidant and anti-inflammatory effects, promoting ulcer healing, and combating <i>Helicobacter pylori</i> infection. The evidence presented includes in vitro assays, animal models, and some clinical studies. While many of the 53 plants reviewed demonstrated significant anti-ulcer effects compared to standard drugs, further clinical research is needed to establish efficacy and safety in humans. The synergistic actions of phytochemical mixtures in medicinal plant extracts likely contribute to their therapeutic potential. This review highlights the role these North African medicinal plants may play in the prevention and treatment of peptic ulcers and identifies promising candidates for further research and development of evidence-based botanical therapies.
Medicinal Plants for Peptic Ulcer Disease 4.1.1. Abelmoschus esculentus A. esculentus , commonly known as okra or lady's finger. A. esculentus has been traditionally used in certain herbal medicine systems for gastrointestinal health (Ortaç et al. 2018 ). A. esculentus contains mucilage, a gel‐like substance that is known for its demulcent properties. Mucilage can form a protective layer over the gastric mucosa, helping to soothe irritation and inflammation in the stomach lining (Naim et al. 2015 ). Additionally, several studies illustrated Okra is rich in antioxidants, including flavonoids, polyphenols, and vitamin C, which can help neutralize harmful free radicals in the body (Joshi et al.
Those compounds are well known for their antioxidant properties, anti‐ulceration, anti‐inflammation (Boutemak, Safta, and Ayachi 2015 ), and anticancer activities (Es‐Safi et al. 2006 ). These findings suggest that G. alypum has the potential to offer gastroprotective benefits, making it a promising candidate for further exploration in gastroprotection research. Nevertheless, further research, including preclinical and clinical studies, is needed to elucidate its efficacy and safety for the prevention and treatment of peptic ulcers and other gastrointestinal disorders. 4.1.21. Glycyrrhiza glabra Licorice derived from the roots of G.
Lavender has been traditionally used for its calming and stress‐relieving properties. By reducing stress and anxiety levels, lavender may indirectly help prevent ulcers and promote gastrointestinal health (Javed et al. 2020 ). 4.1.28. Lawsonia inermis L. L. inermis , commonly known as henna, exhibits therapeutic effects on gastric ulcers. Studies have shown that L. inermis possesses anti‐ulcer properties (Elansary et al. 2020 ; Moutawalli et al. 2023 ).
Additionally, purslane contains omega‐3 fatty acids, flavonoids, and polysaccharides, which have demonstrated anti‐inflammatory properties. Chronic inflammation is a contributing factor to the development and progression of gastric ulcers. By reducing inflammation in the stomach lining, purslane may aid in the healing process of gastric ulcers (Kumar et al. 2010 ). 4.1.45. Punica granatum Studies have explored the potential of P. granatum , or pomegranate, in treating and preventing stomach ulcers due to its traditional medicinal use and perceived health benefits. It is believed that P.
These compounds may help reduce inflammation in the gastrointestinal tract and protect the gastric mucosa from damage. Further, Ziziphus species contain antioxidants that help scavenge free radicals and reduce oxidative stress. By protecting against oxidative damage, these antioxidants may contribute to the maintenance of gastric health and the prevention of gastric ulcers. Research indicates that Ziziphus extracts may exhibit anti‐ulcer activity by reducing gastric acid secretion, inhibiting the activity of enzymes involved in ulcer formation, and promoting the healing of gastric ulcers.
Overall, plant‐derived compounds like EGCG play a crucial role in facilitating gastric mucosal healing by promoting epithelial cell proliferation, fostering angiogenesis, and mitigating inflammation and oxidative stress. By accelerating ulcer healing and restoring the structural integrity of the gastric mucosa, these compounds offer promising therapeutic benefits in the management of peptic ulcers, reducing the likelihood of ulcer recurrence and improving clinical outcomes for affected individuals (Rodríguez‐Negrete et al. 2024 ). 5.6.
By modulating the activity of these proton pumps, DGL effectively reduces the production of gastric acid, leading to decreased acidity within the stomach. The reduction in gastric acid secretion achieved by DGL offers several benefits in the management of peptic ulcers. Firstly, it helps alleviate symptoms such as abdominal pain, heartburn, and indigestion, which are often exacerbated by excessive gastric acid secretion. By lowering acid levels, DGL provides symptomatic relief, improving the overall quality of life for individuals with peptic ulcers. Moreover, the reduction in gastric acid secretion creates a more favorable environment for mucosal healing.
Abstract OBJECTIVE: To systematically evaluate the clinical efficacy of Licorice Heart-draining Decoction(LHDD) plus reduction combined with western medicine in the treatment of oral ulcer (OU) after chemotherapy for malignant tumors. Methods: A computerized search of Chinese and English databases, such as CNKI, Wanfang database, Wipro database , Pubmed Centeral, Dutch Medical Abstracts Database , Cochrane Library, was performed to retrieve all the related clinical Randomized controlled trials (RCTs) were conducted, and valid data were extracted after literature screening and quality evaluation, and Meta-analysis was performed based on RevMan 5.3 software. RESULTS: Nine papers with a total of 1421 patients were included in the RCTs, and the results of Meta-analysis showed that the clinical efficacy rate of LHDD combined with conventional western medicines in the treatment of oral ulcers of malignant tumors treated with chemotherapy in the experimental group was higher than that of the control group [OR=4.20, 95% CI (2.90,6.07), Z=7.63, P<0.01]. The recurrence rate was lower in the test group than in the control group [OR=0.34, 95% CI (0.20, 0.56), Z=4.16, P<0.01]. CONCLUSION: The clinical efficacy of LHDD combined with conventional western drugs in treating OU after chemotherapy for malignant tumors is better than that of using western drugs alone.
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Meta-analysis of Licorice Heart-draining Decoction
combined with western medicine in the treatment of
oral ulcers after chemotherapy for malignant tumors
Wang Zihan
Shandong University of Traditional Chinese Medicine
Dong Meng
Shandong University of Traditional Chinese Medicine
Wang Shihao
Shandong University of Traditional Chinese Medicine
Dou Mengyu
Shandong University of Traditional Chinese Medicine
Kang Yongqi
Shandong University of Traditional Chinese Medicine
Sun Wenchen
Shandong University of Traditional Chinese Medicine
Liu Wenhao
Shandong University of Traditional Chinese Medicine
Li Yuqiu ( xiaoyusd@sina.com )
Shandong University of Traditional Chinese Medicine
Article
Keywords: Licorice Heart-draining Decoction, Oral Ulcer, Meta-analysis, Chemotherapy, Malignant Tumor,
Randomized Controlled Trial
Posted Date: September 22nd, 2023
DOI: https://doi.org/10.21203/rs.3.rs-3339544/v1
License: This work is licensed under a Creative Commons Attribution 4.0 International License.
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signaling pathway, thus reducing the production of TNF- α , IL-1 β , IL-6, IL-8, and playing an anti-
inammatory role to promote the recovery of oral ulcers. β -sitosterol anti-inammatory mechanism, in
addition to inhibiting the cellular inammatory signaling pathway, has an inhibitory effect on the activity
of pro-inammatory mediator synthase 5-lipoxygenase and cyclooxygenase-2, and also has an inhibitory
effect on the activity of 5-lipoxygenase, 5-lipoxygenase, and cyclooxygenase-2. In addition to inhibiting
cellular inammatory signaling pathways, β -sitosterol has an important anti-inammatory effect on the
pro-inammatory mediator synthases 5-lipoxygenase and cyclooxygenase-2[20]β -Sitosterol also has a
certain ability to scavenge reactive oxygen radicals because of its triterpene structure. In the reaction
system of lipid mediators, hydrogen transfer reaction is the key to scavenge moderately reactive oxygen
radicals by β -sitosterol, and the formation of radical adducts is the mechanism to scavenge strongly
reactive oxygen radicals by β -sitosterol. Studies have shown that baicalein has strong anti-inammatory
and antibacterial properties, not only inhibiting staphylococci and pneumococci[21–22], inhibit various
pathogenic fungi of the skin, and inhibit the proliferation of oral bacteria. Baicalein, as the main extracted
ingredient of LHDD, can maintain oral health and promote the healing of ulcerated surfaces by regulating
the microenvironment of oral ora and inammatory mediators. Kaempferol is an antioxidant that
eliminates reactive oxygen species and exerts antioxidant effects, which is important for the treatment of
potential diseases of the oral mucosa. Shen Yunzhang et al.[23] studied the inammatory response of
kaempferol at low, medium and high doses on mice with atopic dermatitis, and proved that kaempferol
can make the inammatory response of mice reduced, and has a protective effect on skin tissues, and in
a certain range of dermatitis, the effect of symptomatic improvement of dermatitis is proportional to the
dose. Soysterol decreased the expression of NF- κ B/P65, inhibited the expression of pro-inammatory
mediators (TNF- α , IL-6, IL-1 β , inducible nitric oxide synthase and cyclooxygenase-2) and increased the
expression of inammatory factors. Wu Lichao et al.[24] demonstrated the anti-inammatory ecacy of
soy sterols by demonstrating through network pharmacology and cellular experiments that soy sterols
can effectively inhibit the levels of inammatory factors IL-1 β and TNF- α , and elevate the level of anti-
inammatory factor IL-10 in inammation models. Huang Jianchun et al.[25] Observed the scavenging
and inhibitory effects of soy sterol on O2- and OH by using in vitro assay method, and veried that both
high and medium concentrations of soy sterol had prominent scavenging effects, and showed
concentration dependence. Cavandinine inhibits the activity of inammatory cells and the release of
inammatory factors, and has signicant therapeutic effects on various inammatory states and
diseases associated with the inammatory response process, mainly involving the NF- κ B signaling
pathway. Cavandinine may protect the ulcer surface by decreasing the levels of IL-6 and TNF- α , inhibiting
the expression of cyclooxygenase 2 and the upregulation of NF- κ B pathway[26] .
The pathogenesis of LHDD in the treatment of post-chemotherapy OU is mainly related to the following
factors: Regulation of gastric acid secretion and promotion of wound healing. Xu Xiupeng[27]
ia was reversed as well, it is possible that the beneficial effect on learning and memory was a result of facilitation of cholinergic transmission. 41
Antinephritic Activity
Glabridin, an isoflavan isolated from G. glabra, improved urinary protein excretion, total cholesterol, serum creatinine, and blood urea nitrogen levels after its oral administration to mice with glomerular disease. 42
Clinical Applications
Licorice is a component of more traditional Chinese and Japanese herbal formulas than any other herb and has been commonly used in Western natural medicine and herbalism for centuries. Although extremely pharmacologically diverse, the current clinical applications of licorice can be divided into four main categories:
• Use of DGL
• Use of oral licorice preparations containing glycyrrhizin
• Use of licorice flavonoid oil (LFO)
• Use of topical preparations containing glycyrrhetinic acid
The key use of DGL is in ulcerative conditions of the gastrointestinal tract (e.g., peptic ulcers, canker sores, inflammatory bowel disease), whereas the key uses of oral licorice containing glycyrrhizin include viral infections (e.g., the common cold, HIV and AIDS, viral hepatitis); premenstrual syndrome (PMS) and menopause; acute intermittent porphyria; Addison’s disease; inflammation; syndrome X; and as a sweetening agent. Topical preparations containing glycyrrhetinic acid can be used in eczema, psoriasis, herpes, and melasma. Deglycyrrhizinated Licorice
Although glycyrrhetinic acid was the first drug proven to promote healing of gastric and duodenal ulcers, 43 most physicians using licorice in the treatment of peptic ulcers now use DGL. DGL was actually shown to be more effective than glycyrrhetinic acid, without side effects. 44
DGL’s mode of action is different than that of current drugs, such as antacids and H 2 -receptor antagonists, which focus on reducing gastric acidity. Although effective, these treatments can be expensive, carry some risk of toxicity, disrupt norm
Licorice flavonoid alleviates gastric ulcers by producing changes in gut microbiota and promoting mucus cell regeneration
## Abstract
Licorice flavonoid (LF) is the main component of Glycyrrhizae Radix et Rhizoma, a "medicine food homology" herbal medicine, which has anti-digestive ulcer activity, but the mechanism in anti-gastric ulcer (GU) remains to be elucidated. In this study, we manifested that LF increased the viability of human gastric mucosal epithelial (GES-1) cells, attenuated ethanol (EtOH)-induced manifestations, reduced histological injury, suppressed inflammation, and restored gastric mucosal barrier in GU rats. After LF therapy, the EtOH-induced gut dysbiosis was partly modulated, and short-chain fatty acids (SCFAs) like butyric acid, propionic acid, and valeric acid were found in higher concentrations. We discovered that the majority of genera that increased in the GU group had a negative correlation with SCFAs in the intestinal tract. In addition, LF-upregulated SCFAs boosted mucus secretion in the gastric epithelium and the expression of mucoprotein (MUC) 5AC and MUC6, particularly the MUC5AC in the gastric foveola. Moreover, LF triggered the EGFR/ERK signal pa
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