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Chapter 7
Medicinal Plants for
Gastrointestinal Diseases
Bui Thanh Tung
VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
Nguyen Thi Nhung
VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
Duong Thi Hai Linh
VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
Ngo Thi Hue
VNU University of Medicine and Pharmacy, Vietnam National University, Hanoi, Vietnam
ABSTRACT
Gastrointestinal (GI) diseases are those that affect the digestive tract. This may include sections from
the esophagus to the rectum and the liver, gallbladder, and pancreas digestive organs. Gastrointestinal
diseases may be acute, chronic, or recurrent. Natural products show the potential ability to treat the
causes and decrease the GI tract production systems. This chapter is to present some of the medicinal
plants that are used to treat and minimize signals of GI disease pathogenesis.
INTRODUCTION
Gastrointestinal diseases are diseases affecting food intake, drinking water, and general health. Gastroesophageal reflux disease (GERD), peptic ulcer disease (PUD), irritable bowel syndrome (IBS), functional
gastrointestinal disorder (FGD), inflammatory bowel disease (IBD), ulcerative colitis (UC), are several
popular forms of digestive diseases. Gastroesophageal reflux disease (GERD) is a widespread condition
with a rate as high as 10%-20% in the western countries, less than 5% in Asia (Badillo & Francis, 2014).
The disease has various symptoms such as clinically troublesome heartburn, regurgitation, chest pain.
There are also other atypical symptoms that may be associated with GERD such as: nausea, epigastric
DOI: 10.4018/978-1-6684-5129-8.ch007
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Medicinal Plants for Gastrointestinal Diseases
pain, dyspepsia, and belching. The protein targets of treatment for GERD are histamine H2 receptor
(H2R) or proton-pump (Katz et al., 2013).
The statistical incidence of peptic ulcer disease (PUD) from hospitalization data is approximately
0.03–0.17% and 0.10–0.19% physicians diagnosed PUD (Sung et al., 2009). The main symptom of peptic
ulcer disease is stomach pain. In addition, some more severe cases can lead to complications such as
gastroduodenal hemorrhage and perforation of the stomach, which is the main cause of high mortality
in patients with peptic ulcer disease. The most common cause of PUD is related to the side effects of
non-steroidal anti-inflammatory drugs (NSAIDs) and the presence of Helicobacter pylori bacteria. The
goal of most medicines is therefore close to GERD in addition to treating the etiology like antibiotics
(Fashner & Gitu, 2015).
Irritable bowel syndrome (IBS) is a chronic digestive disorder that affects approximately 3–20%
of the population of the United States. In Vietnam, the incidence of this disease is about 15-20%, it is
common in people between the ages of 40-60. Poor knowledge of the pathophysiology and causes of
IBS is provided. IBS has no usual signs and it is only discovered when the patient experiences abdominal pain along with bowel abnormalities such as diarrhea or constipation and general weakness if no
abnormalities are present. morphological, histological or inflammatory when there is no the abnormal
morphological, histological or inflammatory markers (Grundmann & Yoon, 2010). Several reports have
lately demonstrated that the etiology of IBS is attributable in part to changes in the function of the nerves
that feed the gastrointestinal tract, activation of the immune system and psychological causes. Enteric
P2X receptors may affect gastrointestinal activities like propulsion and secretion, and the drugs acting
at these receptors could be useful for treatment IBS (Galligan, 2004). Dyspepsia is known to signify
chronic or episodic symptoms of abdominal pain or nausea and it involves the upper gastrointestinal tract
(Heading, 1991). Functional gastrointestinal disorders (FGD) are common, accounting for up to 50% of
gastroenterology referrals (Jackson et al., 2000). FGD is a condition whose Symptoms should be clear
to allow a diagnosis of FGD for at least 12 weeks of the previous year. Of course, it has exceptions. An
example of an exception is persistent abdominal pain that requires symptoms for six months, while other
minors while anorectal pathologies only require symptoms for a few weeks. The cause is not clear so
most medicines treat symptoms primarily (Drossman, 1999).
Inflammatory bowel disease (IBD) is a disease in which the digestive tract is damaged, chronic
inflammation. IBD is ranked as the 5 most common gastrointestinal disorders in the United States,
with total healthcare expenses costing more than $1.7 billion, and is a chronic illness (Malaty et al.,
2010). Genome-wide association studies have identified multiple inflammatory bowel disease (IBD)
susceptibility loci, including proteins involved in cytokine signaling and genes encoding cytokines. In
particular, loss-of-function mutations in genes encoding IL-10 and the IL-10 receptor have been shown
to be associated with early onset of IBD. And TNF-specific antibodies can induce mucosal healing in
IBD and inhibit chronic intestinal inflammation (Neurath, 2014). Ulcerative colitis (UC) is a disease
that affects 1-2 million people in the United States, and many more globally. Some symptoms include:
abdominal pain, diarrhea, weight loss, bloody stools, fatigue, and fever. The precise cause of ulcerative
colitis is unknown, the hereditary and environmental variations are risk factors. Several research have
shown that the immune system is associated with UC (Colitis–Pathophysiology, 2003). Platelets may
be triggered dramatically in UC. This can lead to vascular endothelial damage and upset the balance
between TXB2 and 6-keto-PGF1a in blood (Dong et al., 2004).
This has been demonstrated that medicinal plants reduce the effects of different diseases like GI diseases. The effect of complete medicinal plant extract on GI disorders has been shown in several reports.
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Medicinal Plants for Gastrointestinal Diseases
Specific molecules such as flavonoids, anthranoids, triterpenes, and alkaloids have shown numerous
beneficial pharmacology behaviors in GI diseases. We will summarize some medicinal plants used for
treatment of GI diseases below.
Medicinal Plants Used for Treatments of Gastrointestinal Diseases
Carica Papaya
Carica papaya L. (Caricaceae) is normally known for its food and dietary benefits. Papaya organic product is a rich wellspring of supplements like provitamin A, vitamin B, vitamin C, carotenoids, lycopene,
L-ascorbic acid, dietary fiber and dietary minerals. It is known similarly as with diuretic ready and treatment heartburn. The Papaya fruit is purgative which guarantees of customary defecation. The smooth
juice which is tapped from the green, mature natural product while still in the tree contains a compound
known as “papain” which is utilized in various solutions for heartburn (Yogiraj et al., 2014). In addition,
Carica papaya has also been shown to have a healing effect on the stomach. In an experiment on rats
with stomach ulcers caused by aspirin, they were given 400mg/kg of Carica papaya fruit extract orally
for 7 days and the ulcer index was significantly reduced (Ologundudu et al., 2008).
Zingiber Officinale
Zingiber officinale is a medicinal herb that has an important role and is widely used in medicine in
Vietnam, China, Ayurveda, Siddha, etc. Ginger contains various nutrients such as fats, proteins, fibers,
carbohydrates, proteases, lipids, essential vitamins, and minerals for the body. It also contains vitamins
such as thiamine, riboflavin, niacin, and vitamin C. These substances can be isolated from Zingiber
officinale as gingerols, adenine, acetoxy-6-dihydroparadol, shogaol, paradol, and 2,3-dihydroxy hexacosanoic acid, propyl ester, maleimide-5-oxime, etc (Kumar et al., 2011). The extract of Ginger has
anti-inflammatory and antioxidant properties, that can reduce the severity of ulcerative colitis (El-Abhar
et al., 2008). Studies in rats also shown an inhibitory effect on gynecomastia of this herbals. In addition, ginger is effective in curing spasms caused by isolated acetylcholine or by electrical stimulation
(EFS). Ginger inhibits both of these contractions more strongly than inhibits EFS-induced contractions
(Borrelli et al., 2004). Moreover, the methanol extracts of Zingiber officinale (ginger rhizome/root) and
Rosmarinus officinalis (rosemary leaf) were assessed for the susceptibility of fifteen H. pylori strains
had with MIC of 25 µg/mL, which is useful in peptic ulcer disease (Mahady et al., 2005).
Cynara Scolymus
Cynara scolymus is a traditionally consumed vegetable in many countries. This herbal contains some
chemical composition like polyphenol, axit caffeic, axit chlorogenic, flavonoid, quercetin, gallic acid
and ascorbic acid và cynarin and antioxidant properties (Lutz et al., 2011). Cynara scolymus has several
good effects in the gastrointestinal tract. Artichoke extracts which were well tolerated, had a strong prebiotic influence on the composition of human faecal microbiota. A study was conducted to evaluate the
effect of Cynara scolymus leaf extract on healthy volunteers with dyspepsia, the result showed a 26.4%
reduction in the incidence of IBS after treatment.
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Medicinal Plants for Gastrointestinal Diseases
Aloe vera
Aloe vera is a succulent plant belonging to the lily family, it has good drought tolerance. Since ancient
times, Aloe vera has been known and used by people as a medicine to help treat constipation, wounds,
coughs, diabetes, anti-cancer and many other diseases. Aloe vera gel includes over seventy bio active
compounds such as anthraquinones, carbohydrates, chromones, lupeol, salicylic acid, urea nitrogen,
cinnamic acid, phenols and sulfur, proteins, vitamin A, B12,C, E, choline and folic acid, auxins and gibberellins (Verma, 2011). And it is claimed to have healing, anti-inflammatory, anti-oxidant, anti-ageing,
anti-cancer and immune boosting properties (Hutchings et al., 2011). Aloe vera gel can reduce symptoms
in patients with mild to moderately active UC. It has been shown to be safer and more effective than
a placebo. (Langmead et al., 2004). A study on the treatment of symptoms of gastroesophageal reflux
disease (GERD) with Aloe vera found that it was more effective when compared with the benefits of
omeprazole and ranitidine (Panahi et al., 2015). Moreover, this herbal also has the therapeutic potential
of inflammatory bowel disease (IBD) and is recommended for the treatment of symptoms of irritable
bowel syndrome (IBS) symptoms (Davis et al., 2006).
Cleistocalyx Operculatus (Roxb.)
The flower buds of Cleistocalyx operculatus are found in many herbal products and herbal teas. From
the shoots of C. operculatus, 55 essential oil compounds were isolated. The oil was able to significantly
inhibit the growth of food-borne bacteria (FB), food spoilage (FS), methicillin-resistant Staphylococcus
aureus (MRSA), skin pathogens (SP), multi antibiotic-resistant bacteria (MARB), and vancomycinresistant Enterococci (VRE). The ethanol extract demonstrated superior antibacterial activity against
all gram-positive bacteria and a gram-negative food spoilage bacterium known as P. aeruginosa (Dung
et al., 2008). The leaves of Cleistocalyx operculatus contain methanolic which have anticaries activity
against S. mutans in acid production and biofilm formation (Nguyen et al., 2017). Extracts of Cleisto-
calyx operculatus buds have anti-inflammatory activity, reducing inflammatory responses by blocking
the expression of inflammatory cytokines. In a study on RAW 264.7, a mouse macrophage-like cell line,
was shown to significantly inhibit the lipopolysaccharide (LPS) secretion of C. operculatus shoots. This
leads to a decrease in inflammatory factors such as interleukin-1β (IL-1β) and tumor necrosis factor-α
(TNF-α), which in turn suppresses the mRNA production of TNF-α and IL-1β (Dung et al., 2009). The
study in an experimental LPS-induced sepsis rats model and in macrophages showed that both ethanol
extract of flower buds (ECO) and its major constituent increased the nuclear translocation of the nuclear
factor erythroid 2-related factor 2 (Nrf2), as well as the expression of Nrf2 target genes, including heme
oxygenase-1 (HO-1), in macrophages (Tran et al., 2019).
Rheum palmatum L (Rhubarb)
Rheum palmatum is a perennial plant native to Asia. It includes the genus Rheum, which is in the
Polygonaceae family. Rheum palmatum have an extended background of mainstream Vietnamese and
Chinese medicine as medicinal plants. The roots and stems contain a lot of anthraquinones, like rhein
and emodin (1,3,8-trihydroxy-6-methyl-9,10-anthraquinone). They have a laxative effect, which explains
the frequent misuse of Rhubarb as a slimming agent (Ashnagar et al., 2007). Rheum palmatum has many
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