POSSIBILITYIES OF PHYTOTHERAPY AT DIGESTIVE SYSTEM DISEASES

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The prevention and cure of diseases of the digestive system are the most important medical problems. As the main causes of disease of gastrointestinal tract usually point out such interconnection endogenous and exogenous factors, as disorder of neurohumoral and endocrine regulation of secretory and digestive processes, a bacterial infection, long-term using of some medicines (so-called «medicine gastritis»), inconsistent and poor nutrition, neuro-emotional overstress, poor quality of food products and others [1]. As a rule, disturbances of the digestive system are characterized by the involvement of this pathological process of anatomically and functionally related systems and organs [2, 3]. In this way, therapy in gastrointestinal practice usually include medicines, that are directly influenced on secretory, gastric evacuation and digestive functions, on intestinal microflora for normalization and also on excretory activity of the pancreas and liver [1, 4]. A specific feature of phytotherapy is that it’s difficult to mark out the pharmacological group of medicinal plant in comparison with synthetic medicines [5]. This is due to the fact that preparations on the base of medicinal plants combine wide range of pharmacological activities. Phytopreparations taken «per os» work by medical act in the place of delivery. Phytopharmaceuticals reveal total therapeutic effect, in which necessarily high- lighted the main pharmacological activity. By the way, it is very important to show such characteristics of phytopreparations as the mildness of phytopharmaceutical activity, ability to prolongation of the therapeutic effect of synthetics medicines. Special significance of medicinal plants is relative safety that is very actual in long-term using for chronic diseases [2, 3]. In the light of above, we can identify the most important group of medicinal plants, which are used in the treatment of diseases of the digestive system: anti-microbial, anti-inflammatory, enveloping, regenerating (anti-ulcer, wound healing), spasmolitic, cholagogue, laxative, astringent, hemostatic, hepatoprotective and bitterness [3]. Herbal plants have leading value in the treatment of gastrointestinal inflammatory diseases such as colitis, and enterocolitis, that are containing tannins. This group of biologically active substances (BAS) case the astringent, anti-microbial, anti-inflammatory effect. Astringent effect is realized due to the interaction of tannins with the mucosa membrane (due to the presence of numerous phenolic groups). Proteins irreversible connect in strong connections with formation thin, but thick membrane. This membrane prevent irritating action of substance on intestine, also it averts further inflammation of painful nerves. At the same time there is a local vasoconstriction with reduction of permeability, reducing of exudation and of enzymes inhibiration. So, that is way, there is inhibition of development of the inflammatory process. Astringent preparations are attributed to anti-inflammatory (antiphlogistic) local medicines, which reduce the sensitivity of esodic nerve endings and pre- vent their innervation [3, 4, 6]. The astringent properties have such medicinal plants as Quercus robur L. (English oak), Sanguisorba officinalis L. (greater burnet), Padus avium Mill. (European bird cherry), Vaccinium myrtillis L. (blueberry), Hypericum perforatum L. (commom Saint-John’s wort), Potentilla erecta (L.) Rausch. (tormentila cinquefoil) [3]. However, the well known trends of using English oak’s bark. The decoction of the bark of Quercus robur has a strong irritation action on the stomach mucous membrane, that is caused of nausea and even vomiting, especially in children. So, that’s is way, bark of Quercus robur L. is used like as an external astringent [7]. The leading part in diarrhea treatment in pediatric practice have water extraction from the fruit of Padus avium Mill. and Vaccinium myrtillis L. Infusion of blueberry is used to cure non-specific acute diarrhea for babies and toddlers. The decoctions are administered for tree-year-old children [3, 8]. It is important to note, that the presence in the fruits of Vaccinum myrtillus L. such anthocyanins as delphinidine, malvidin and their various derivatives (a mixture of these substances is called “myrtillin”) connected with the hypo- glycaemic effect of herbal materials, which is a valuable addition to its main astringent property [3]. In case of children in situations of diarrhea, dyspepsia, susceptibility to meteorism fruits of Foeniculum vulgare Mill. (medicinal fennel) are effective remedy for newborn babies. There is a considerable advantage of water extraction of medicinal fennel such as good organoleptic qualities, availability of herbal materials, reliable and proved in pediatric practice, the opportunity to get this medicine with mother’s milk. The infusion of Foeniculum vulgare Mill. fruits not only completes loss of liquid in the organism, but due to carminative effect reduces flatulence, colic and intestinal spasms [3, 5, 8]. It’s important to note herbal materials contained polysaccharides that also decrease sensitiveness of esodic nerve endings. For examples, seeds of Linum usitatissimum L. (fiber flax), radices of Altheae officinalis L. (marshmal- low). Preparations based on that, are used on high peracidity for protection mucus membrane against damage influence. Mucus these and other plants envelops and protects the inflamed mucous, including of stomach irritation by hydrochloric acid, bile components, food, medicines. In addition, they have anti-inflammatory properties, and some of them - laxative effect [3, 4, 6]. With all the advantages of polysaccharides, it would be noticed, that the roots of marshmallow should not be administered with pancreatitis and diabetes. Due to the presence bitter substance the using of Plantago major L. (common plantain) is limited in the case of hyperacidity states. In case of administration of solution from seeds of Linum usitatissimum L. it is limit of application in disorders with cholecystitis, because long-term using of water extract could be intensify pain. Moreover, it had written, that the combine using of solution of fiber flax’s seeds with other medicines an delay their absorption [7]. Eucalyptus viminalis Labill. is interesting plant for the use because of its bacterial activity in case of gastrointestinal inflammatory diseases. In case of dysbiosis important stage of treatment is influence on relative-pathogenic microflora by means of antibacterial preparations. Phytopharmaceuticals based on leaves of Eucalyptus viminalis Labill. called “Chlorophyllipt” is administered in staphylococcal form of dysbacteriosis [9]. The pharmacological effect of Eucalyptus viminalis Labill. leaves and drugs based on it contribute monoterpenoids components of the essential oil. However, at first time high antimicrobial activity expressed due to the presence of euglobales (phenolaldehydes of terpenoids) [3]. Tannins increase activity, which are characterized as an antimicrobial effect [3]. Phytotherapy has a successful approach for fighting with pathogens in case of dysbacteriosis. In the majority of medicinal plants are intestinal eubiotics, they destroy pathogens microflora and safe saprophytic microflora. It’s their basic advantage in comparison with synthetic drugs. Furthermore, in case of herbal materials it is noted the minimum risk of the occurrence of resistance of microorganisms. That’s why in herbal teas it is reasonable to combine medicinal plants with antimicrobial, antiviral, antiprotozoic, fungicidal and vermicide properties. It’s must be herbal materials that contain tannins, essential oils, flavonoids [1]. The group of medicinal plants, stimulating the appetite, present the big interest. Bitter substance is a cause of these properties. These substances are often iridoids or iridoid glycosides (compounds that based on iridan nucleus with monoterpenes derivatives). Bitter compounds have also chemical nature of diterpenoids, phloroglucinol, nonvolatile sesquiterpene. Are known other substance with bitter taste which have such chemical structure as alkaloids (quinine), flavonoid glycosides (hesperidin), steroids. Нowever they are not used in medicine as secretory phytopreparations [3, 10]. These substance stimulate gastric acid secretion primary by effecting taste receptors lingual papillae on the basis of the tongue and for the second time by releasing of gastrin, when bitter get into stomach with food. Gastrin stimulates motility of the upper gastrointestinal tract, as well as the secretion of bile and pancreatic juice. Bitter glycosides cause no additional effect at patients with normal secretion. However, an overdose can cause the opposite effect. The most well-known representatives of this group are the roots of the Taraxacum officinale Wigg. (common dandelion), leaves of Menyanthes trifoliata L. (common bog bean), herb of Centaurium umbellatum Gilib. (common centaury), rhizomes of Acorus calamus L. (sedge cane), herb of Arthemisia absinthium L. (common wormwood). The general contraindications for the application of this pharmacological group is the presence of hyperacidity gastritis, gastric ulcer and duodenal ulcer [1, 3, 4, 5]. The significance of phytotherapeutic resources proved that fact that some of the medicinal plants are indicated for the treatment of gastric ulcer and prevention of recurrence [1]. Gastroprotective properties are realized through reparative mechanism and enveloping properties by biological active substance. For example, carotenoids of fruits of Hippophae rhamnoides L. (sea buckthorn) regenerate membrane of stomach and intestines. It should be noted, that strong bactericidal role of phenylpropanoids has plantamajoside contained in leaves Plantago major L. It’s well-known fact nowadays that in the etiology of peptic ulcer and chronic gastritis connect with at the first place with bacteria Helicobacter pylori [3, 10]. The mechanism of anti-ulcer action of Clycyrrhiza glabra L. roots (common licorice) is due to the glycyrrhizinic acid, that is involved in formation of the protective layer by increasing the resistance to hydrochloric acid, increasing the viscosity of mucus overlying the mucous membrane of stomach. There are stimulation of the division and differentiation of epithelial cells, inhibition of the transition of pepsinogen to pepsin, inhibition of synthesis of thromboxane and prostaglandin’s destruction. Also, glycyrrhisin acid shows the solubilizing properties, that is ability to increase the solubility of other substances. However, it is noteworthy that other triterpene saponins and flavonoids of Clycyrrhiza glabra L. contribute their effect in the treatment of this nosology [3, 5]. Herbal materials make an important significance with anti-inflammatory activity in gastric ulcer and duodenal ulcer. Matricaria chamomilla L. (German chamomile) is one of the most perspective medicinal plants with this activity. Pharmacologically proved, that Chamomile᾽s flowers have anti-inflammatory and spasmolitic activity. Also, it is noted bacteriostatic, fungistatic and carminative actions. Chamomile is effective in different diseases of the mucous membranes, so that is way the areas of it’s application in medicine are very wide. However, according to scientists᾽s research about the anti-ulcer properties is particularly topical using of Chamomil’s flowers against gastroenterological diseases [5]. It has proved by pharmacologists, that due to bisabolol as a leading component of essential oil, can inhibit the development of ulcerative process, forming under the influence of indomethacin, stress or alcohol. There is the acceleration of healing of ulcers and local stimulation of prostaglandin synthesis on account of its increase protective barrier of mucous membrane. The mechanism of action is similar to the causal effect of Licorice as stimulates the formation of mucus that protects the mucous membranes from aggressive acid influence. Mucous substances from Matricaria chamomilla L. have the local protective and anti-inflammatory effect. In some experimental models the Chamomile also show an immunostimulatory effect. It should be noted the role of flavonoids as a second significant group of active substances in Сhamomile herbal materials. Some authors compared their spasmolitic action, comparable to equivalent doses 1/3 spasmolytic effect of papaverine. Anti-inflammatory effects of flavonoids associated with inhibitory effects on prostaglandinsynthetase and lipoxygenase. So that is way taking into account the overall therapeutic effect of Chamomile’s flowers are represented by one of the leading herbal materials for this pathology [3, 5]. An important component in the treatment of the gastrointestinal diseases are the species of phytopraparations, which have spasmolitic action, and to those in the first place should include herbs that contain as the leading group of essential oils and alkaloids. One of the powerful spasmolitic medicinal plant is Atropa belladonna L. (belladonna). The action of belladonna’s alkaloids is blocking the m-cholinergic receptors in the interaction with acetylcholine. Tropane alkaloids have anticholinergic effects and parasympathikolitic that are cause of relaxation of nonstriated muscles of internal organs and the removal of spasms in the gastrointestinal tract and biliary tract [4, 11]. The main indication of using Belladonna’s medicines are colic pain in the stomach and peptic ulcer disease. The inhibition of gastric acid secretion due to anticholinergic action - is another justification for the application of Belladonna. Belladonna is blocking muscarinic receptors peptic glands and muscle lining of the digestive tract. However it is known that it is necessary to use only standardized preparations of Belladonna (“Bellalgin” “Bellastezin” “Besalol” etc.) [4, 11, 12, 13, 14]. The most efficiency of this drugs is observed after 1-1.5 hours after aplication. The duration of action are 2-4 hours. Therefore, preparations are used for 30 minutes before a meal on purpose that their maximum action coincided with the secretion of gastric juice. According to the many-sided character of gastrointestinal problems, the medicinal plants with choleretic activity have a particular importance as point at issue. Appointment of сholagogue phytopharmaceuticals requires differentiated approach demand on the presence of infl and the type of dysfunction [2]. Choleretic activity of herbal materials usually realized due to the presence of various native chemical groups. That is why usually herbal material have a combined pharmacological effect. It should be pick out choleretic herbs of the following pharmacological groups, namely choleretics, cholekinetics, cholespasmolitics [1, 3, 15, 16, 17]. The choleretics (cholesecretic, true stimulant of bile) are remedies of stimulating the formation of bile. Choleretics increase the formation of bile by hepatocytes, and its current flow into the gallbladder, prevent the formation of gallstones, increased secretory and motor activity of the gastrointestinal tract [18]. Examples of choleretic remedies could be herbal materials containing mainly flavonoids, iridoids and essential oils. The same properties also have vegetable fatty oils (e.g., olive oil) [1]. Cholekinetics (cholecystokinetics) called agents that increase the tone of the gall bladder, strengthen its contraction, as well as relaxing biliary ducts and sphincter of Oddi. The cholekinetic properties have some choleretics, exactly medicinal plants containing flavonoids and bitterness. In this way it can be noted medicinal plant containing flavonoids - Datisca cannabina L. (bastard hemp). Cholespasmolitics are the drugs that relax the nonstriated muscles of the gallbladder and biliary tract. Сholespasmolitiс activity has medicinal plants containing alkaloids, such as Atropa belladonna L., Berberis vulgaris L. (European barberry), Chelidonium majus L. (greater celandine) (substance - chelidonine, coptisine). Furthermore, this properties have medicinal plants containing essential oils. Cholespasmolitic promotу to eliminate pain, but it should take into account that long application of m-anticholinergics may increase the stagnation of bile in the gallbladder [1, 3, 15, 16, 17]. Despite the fact that the normalization of lipid and protein metabolism and membrane stabilizing action carried out with the help of hepatic and antioxidants remedies, plants with choleretic properties also have hepatoprotective activity. Above-mentioned classification of medicinal plants influenced on liver and bile duct has very relative character. For the purpose of therapeutic efficacy it’s reasonable to combine the medicinal plants of all 3 groups. This approach usually realize in formulation of many phytopharmaceuticals. Thus, anti-inflammatory and spasmolytic activities of Tanacetum vulgare L. (tansy) flowers manifested by the presence of the essential oil, wherein the choleretic effect is due to the second group of biological active compounds - flavonoids [1, 3, 15, 16, 17, 19]. An important role in the prevention and treatment of diseases of the digestive system play a hepatoprotective agents. This is a relatively small group of medicinal plants for which the hepatoprotective effect is the main or having an independent clinical significance. It is assumed that the effect of these drugs is aimed at restoring homeostasis in the liver, increased organ resistance to pathogenic factors, and normalization of the functional activity of stimulating reparative and regenerative processes in liver. Hepatoprotectors are the remedies of protecting liver cells from any damaging factors which improve the metabolism in the liver, increase the antitoxic liver function. Hepatoprotectors prevent degenerative processes in the liver [16, 17]. Among hepatoprotectors the absolute leader is Silybum marianum L. Gaertn. (milk thistle). Flavolignans of this medicinal plant have powerful antitoxic properties [16, 17]. Uniqueness flavolignans as hepatoprotectors is that their mechanism of action is not implemented only by the antioxidant activity, resulting in inhibition of lipid peroxidation, as in the case of many flavonoids, but also due to the normalization of metabolism in hepatocytes. Action is localized on the hepatocyte cell membrane and intracellular [3, 10]. Value of the milk thistle’s preparations is that they have antioxidant and immunomodulatory properties. Hepatoprotectors produced from such medicinal plants as Cynara scolymus L. (artichoke) (“Hofitol”), Chelidonium majus L. (greater celandine) (“Gepatofalk plantations”), Cucurbita pepo L. (common pumpkin) (“Tykveol”), Curcuma longa L. (common turmeric) (“Holagogum”), and others [3, 10, 11, 12, 13]. The most important pharmacological groups of medicines used in pathologies of the gastrointestinal tract, are herbs that have laxative effects. The dominant source of these phytopharmaceuticals are leaves of Cassia aquifolia Del. (Indian senna) containing anthraglycosides (“Senade”, “Senadeksin”, “Glaxo”, “Regulaks” and others) [11, 12, 13]. Preparations based on Indian senna practically superseded competitive analogues of herbal remedies with anthraglycosides in its composition, although in comparison with preparations of Indian senna, such medicinal plants as Frangula alnus Mill. (alder buckthorn) and Rheum palmatum L. (palmate rhubarb) exhibit less pronounced irritant effect on the intestinal mucous membrane [3, 7]. The action of herbal anthracenderivatives laxatives mainly attributed with hydrolysis of anthraquinones (rhein, emodin, hrizatsin) to aglycon in an alkaline environment of the small intestine under the influence of the digestive and bacterial enzymes. Aglycons accumulate in the large intestine, causing irritation of chemoreceptors, stimulation of intermuscular plexus and increased bowel motility [1, 14, 20]. However, in case of their systematic admission a tolerance come into existence. With prolonged using aglycones of anthraglycosides can accumulate in the colon mucous membrane, causing chronic habitual constipation, forming an inert bowel syndrome. As a result of gradually developing the inflammatory process. In some cases this can lead to ulcerations of mucous membrane and even colon melanosis [1, 21]. Therefore, in order to avoid the phenomenon of addiction phytopraparations containing anthraquinones are recommended to alternate with laxatives another mechanism of action (vegetable oils, medicinal plants containing pectins and fibers) [7]. It is also necessary to take into account such features of anthraquinones as the ability to cause blood inflow to the pelvic organs, contributing to the reduction of the uterus, as well as the ability to penetrate into the breast milk of nursing mothers, causing diathesis in children [7]. Thus, consideration of the medicinal plants which used in the treatment of gastrointestinal diseases, at the position of the relationship “biologically active compound-pharmacological activity” taking into account with complexity of the therapeutic action of herbal drugs allows a rational phytotherapy.

About the authors

A. V Kurkina

Samara State Medical University

Email: kurkina-av@yandex.ru
Samara, Russian Federation

V. R Galyamova

Samara State Medical University

Email: vengal885@gmail.com
Samara, Russian Federation

V. A Kurkin

Samara State Medical University

Email: kurkinvladimir@yandex.ru
Samara, Russian Federation

E. V Avdeeva

Samara State Medical University

Samara, Russian Federation

References

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