A Review: Effective Ulcer Healing

Abstract

Gastric ulcers, a persistent health issue, have a significant likelihood of recurring and can lead to unexpected complications like bleeding, narrowing, and perforation. In recent decades, advancements in clinical treatments for gastric ulcers have enabled the swift creation of potent anti-ulcer drugs. While traditional treatments for gastric ulcers, including H2-receptor antagonists, are effective, proton pump inhibitors (PPIs) play an essential role in promoting ulcer healing and avoiding complications. Despite the progress made, some patients continue to experience recurrence or persistent issues even with ongoing anti-ulcer treatments. A novel concept known as the quality of ulcer healing (QOUH) was developed, focusing on restoring the mucosal structure and function to help prevent the return of ulcers. While various gastro protective measures have contributed to the successes of QOUH, we discovered that natural product-based gastro protection, particularly a new formulation derived from Artemisia or S-allyl cysteine from garlic, demonstrated significant effectiveness in QOUH, alongside alleviating clinical symptoms with reduced side effects. This review will highlight the significance of QOUH in ulcer healing and the advancements gained from natural products. Reduced side effects, even though various gastro protective measures have contributed to the success of QOUH.

Introduction

• The terminology for wounds linked to chronic illnesses has evolved; such wounds are now referred to as complicated ulcers, not just complicated wounds.

• Key characteristics of complicated ulcers:

  • Ulcers that do not improve after three months.

  • Presence of infection.

  • Reduced tissue viability due to necrosis or poor circulation.

  • Connection to systemic conditions that impair healing.

• Diabetes is a leading cause, with diabetic foot ulcers (DFUs) being a major subtype.

• Global diabetes prevalence: 6.3%, highest in North America (13%) and lowest in Oceania (3%).

• Diabetic foot ulcers are a significant cause of non-traumatic lower limb amputations:

  • 15% of DFU patients require amputation.

  • 25% of diabetic patients experience ulcers in their lifetime.

2. Types of Ulcers

A. Peptic Ulcers by Location:

• Gastric, duodenal, and esophageal ulcers.

B. Leg and Foot Ulcers:

• Venous ulcers: poor blood return to the heart.

• Arterial ulcers: poor blood supply to tissues.

• Diabetic foot ulcers: circulation and nerve damage.

C. Other Ulcers:

• Skin ulcers: pressure ulcers, lichen planus.

• Mouth ulcers (canker sores).

• Genital ulcers.

• Corneal ulcers: infection or inflammation of the cornea.

3. Causes of Ulcers

Common Causes:

• H. pylori infection.

• NSAID use (ibuprofen, aspirin).

Other Causes:

• Medications (corticosteroids, antidepressants).

• Severe illnesses (Crohn’s disease, cancer, burns).

Factors worsening symptoms:

• Stress, spicy foods, alcohol, caffeine—do not cause ulcers but exacerbate symptoms.

4. Diabetic Foot Ulcers (DFUs)

• DFUs are a severe complication of diabetes, leading to infection, gangrene, sepsis, and amputation.

• Chronic inflammation in DFUs impedes healing.

• Wound healing stages include:

  • Hemostasis: vasoconstriction, platelet aggregation.

  • Inflammation: neutrophil recruitment, cytokine release.

  • Proliferation and migration: keratinocyte proliferation, angiogenesis, macrophage activation.

5. Treatments for Ulcers

A. DFU Management

• Hydrogel applications: enhance healing by maintaining moisture and promoting cell migration.

• Debridement, topical antibiotics, growth factors, skin replacements, compression therapy for venous ulcers.

B. Peptic and Gastric Ulcer Treatments

• Antacids: effective in duodenal ulcer healing but not symptom reduction.

• Endovenous ablation: effective for resistant venous ulcers.

• Plant-based therapies: aloe, licorice, flavonoids show potential but limited clinical evidence.

• Vitamin U, Belladonna, Aluminum + Omeprazole: improves healing, reduces recurrence, and increases H. pylori eradication.

C. Mouth Ulcers

• Vitamin B complex (B1, B2, B3, B5, B6, B12, folic acid) supports tissue repair, enzyme activity, and red blood cell production, accelerating healing.

6. Research Approach

• Systematic review using English and Persian sources over the past 20 years.

• Databases: Google Scholar, PubMed, Science Direct, Magiran, Springer.

Conclusion

The significance of eradicating H pylori in cases of ulcer disease is clear, yet formulating a treatment strategy can be perplexing. Our review of the literature on eradication shows that 7–14-day treatment courses combining a proton pump inhibitor with clarithromycin and metronidazole are highly effective and generally well accepted. Vitamin B accelerates the healing of ulcers, lowers the chances of recurrence, and enhances the treatment\'s efficacy. Overall, vitamin B offers considerable clinical advantages for addressing mouth ulcers.

References

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Copyright

Copyright © 2025 Tiwatane Bhakti Ravindra, Deokar Shradha Rajendra, Deshmukh Kanchan Bhiku, Shinde Tejaswini Sunil. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.