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             \author[1]{Mohammed  Ibrahim}

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\date{\small \em Received: 2 March 2012 Accepted: 24 March 2012 Published: 8 April 2012}

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\begin{abstract}
        


Helicobacter pylori isa class 1 carcinogen that requires targeted therapeutic strategy. A number of drugs including proton pump inhibitors, antibiotics and antiprotozoals are available for the treatment of Helicobacter pylori infections like chronic gastric irritation, gastro duodenal ulcers and low grade gastric mucosa associated lymphoid tissue lymphoma. Clinical evaluation of these drugs has shown the incidence of relapses, side effects and drug interactions. Multi drug resistance to Helicobacter pylori has been the main reason for treatment failure. This has been the rationale for the development of new anti- Helicobacter pylori drugs and search for novel molecules has been extended to medicinal herbs that offer better protection, decreased relapse and undevelopment of resistance towards bacteria. The present article reviews the medicinal herbs from global perspective for their anti- Helicobacter pylori activity and active compounds from the plants responsible for this activity. We have highlighted some of the important plants and their active constituents reported for their anti- Helicobacter pylori activity. Ancient system of medicine (Ayurvedic and Unani) supported by modern science is necessary to isolate, characterize and standardize the active constituents from herbal sources for anti-Helicobacter pylori activity.

\end{abstract}


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\let\tabcellsep& 	 	 		 
\section[{Exploring Medicinal Plants for Anti-Helicobacter Pylori Activity}]{Exploring Medicinal Plants for Anti-Helicobacter Pylori Activity}\par
Abstract -Helicobacter pylori is a class 1 carcinogen that requires targeted therapeutic strategy. A number of drugs including proton pump inhibitors, antibiotics and antiprotozoals are available for the treatment of Helicobacter pylori infections like chronic gastric irritation, gastro duodenal ulcers and low grade gastric mucosa associated lymphoid tissue lymphoma. Clinical evaluation of these drugs has shown the incidence of relapses, side effects and drug interactions. Multi drug resistance to Helicobacter pylori has been the main reason for treatment failure. This has been the rationale for the development of new anti-Helicobacter pylori drugs and search for novel molecules has been extended to medicinal herbs that offer better protection, decreased relapse and undevelopment of resistance towards bacteria. The present article reviews the medicinal herbs from global perspective for their anti-Helicobacter pylori activity and active compounds from the plants responsible for this activity. We have highlighted some of the important plants and their active constituents reported for their anti-Helicobacter pylori activity. Ancient system of medicine (Ayurvedic and Unani) supported by modern science is necessary to isolate, characterize and standardize the active constituents from herbal sources for anti-Helicobacter pylori activity.\par
Health Organization has categorized H. pylori as a class 1 carcinogen. \hyperref[b4]{5} Eradication of the organism has been shown to result in ulcer healing, prevention of peptic ulcer reoccurrence and may also reduce the prevalence of gastric cancer in high-risk populations. \hyperref[b5]{6} Many clinical trails involving patients with gastric and duodenal ulcers show that curing the infection is associated with a significant reduction in ulcer reoccurrence rates. \hyperref[b6]{[7]}\hyperref[b7]{[8]} Since 1984 physicians prescribing triple therapy to treat H. pylori infections which includes three options.\par
First option includes the combination of proton pump inhibitor (PPI), clarithromycin and ampicillin. Second option includes PPI, clarithromycin and metronidazole. Third option includes bismuth subsalicylate, metronidazole and tetracycline, but the cure rate from standard triple therapy has been low as 50\%. 9-10 However, eradication by the triple therapy is not always successful and acquisition by H. pylori resistance to antibiotics could present a serious problem that may reduce treatment efficiency. \hyperref[b11]{11} Quadruple therapy, where three antibiotics are taken alongside the PPI, has also been used in cases where triple therapy has not been successful. But the success rate was only 67\%. \hyperref[b12]{12} Many strains of H. pylori are now developing resistance to commonly used antibiotics. H. pylory acquires resistance by mutations to all the antibiotics used in the treatment regimens. The mechanism of resistance involves point mutations which are transmitted vertically, however transformation may be possible if two strains are present simultaneously in the stomach. Drug efflux proteins also can contribute to natural insensitivity to antibiotics and to emerging antibiotic resistance. Efflux pump gene hef A of H. pylori play an important role in multidrug resistance. Global resistance of H. pylori to metronidazole, clarithromycin, amoxicillin and tetracycline was also reported. One person may have more than one strain of H. pylori. Here the antibiotics may kill one strain, but not the other. \hyperref[b14]{[13]}\hyperref[b15]{[14]} Furthermore, undesirable side effects of the drugs and the significant cost of combination therapy require the 
\section[{Global Journal of Medical Research Volume XII Issue IV Version I}]{Global Journal of Medical Research Volume XII Issue IV Version I}\par
elicobacter pylori (H. pylori), a Gram -negative 1984 by Marshall et al, is one of the most common chronic bacterial pathogens in humans. 1 Approximately 50\% of people in the world are infected with it, and its prevalence is significantly higher in developing countries than in developed countries. \hyperref[b1]{2} Once a person is infected, the organism can live in the stomach indefinitely and may not cause clinical illness. It is still not clear how H.pylori are transmitted or why some people infected with bacteria become sick and others do not. \hyperref[b2]{3} H. pylori infection is an important etiologic impetus usually leading to chronic gastritis, gastroduodenal ulcer and low grade gastric mucosa associated lymphoid tissue lymphoma.\par
Epidemiological data shows that a high H. pylori infection rate is related to the high incidence of gastric cancer and gastric adenocarcinoma. \hyperref[b3]{4} World H spiral bacterium which was first detected in I. 
\section[{Introduction}]{Introduction}\par
II.\par
Current Treatment Regimens As phytomedicine has proved to be an untapped treasure for the discovery of lead compounds to cure gastrointestinal disorders. Hence several studies have been aimed to evaluate the anti-helicobacter pylori activity of medicinal herbs. \hyperref[b16]{15} To the best of our knowledge, there is no extensive global view on exploring medicinal plants for anti-helicobacter pylori activity. List of medicinal herbs with anti-Helicobacter pylori activity including their source and active extracts are given in table  {\ref 1}.\par
The insolubility of non-polar extracts makes it very difficult for the investigators to be used in an aqueous medium during the study of anti-Helicobacter pylori activity. \hyperref[b26]{26} Water or alcohol (methanol/ethanol) are used mainly for a large number of crude extract preparations. \hyperref[b27]{27} The type of solvent used may have an effect on the nature of the compounds extracted and the resulting bioactivity of the extract. \hyperref[b28]{28} To estimate the value of each extract therefore, several factors, including the rate of extraction, the quantity extracted (yield), the diversity of compounds extracted, the diversity of inhibitory compounds extracted, the ease of subsequent handling of the extracts, toxicity of the solvent in the bioassays and the potential health hazards of the extractants have to be evaluated. In many research works, methanol/ethanol is used for alkaloid extraction; acetone for flavonoids and steroids; hexane, diethyl ether and chloroform for fat soluble oils, wax, lipids and esters. Dichloromethane for terpenoids, ethylacetate for esters, ethanol may be used for sterols, poly phenols, tannins and water for water soluble components like glycosides, polysaccharides, polypeptides and lectins. \hyperref[b29]{29} Hundreds of plants with antimicrobial compounds have been reported. However, very few of these studies have reported the in vivo anti-Helicobacter pylori activity of these compounds. It is very important to know whether these compounds will still maintain their maximum activity in the gastric mucus niche of H. pylori. Anti-Helicobacter pylori compounds from plants and their mechanism of action are given in table \hyperref[tab_2]{2}.\par
Curcumin, biologically active poly phenolic from Curcuma longa has recently been shown to arrest H. pylori growth. The anti-Helicobacter pylori activity of curcumin against 65 clinical isolates of H. pylori in vitro was examined. Minimum inhibitory concentration ranging from 5-50 µg/ml, showing its effectiveness against H. pylori growth in vitro irrespective of genetic makeup of strains. Curcumin showed immense therapeutic potential against H.pylori infection as it was highly effective in eradication of H.pylori from infected mice as well as restoration of H.pylori induced gastric damage.\par
Curcuma longa extract was the most efficient in killing the seven strains of H.pylori within 15 minutes followed by chilli and ginger. \hyperref[b48]{[46]}\hyperref[b49]{[47]}\hyperref[b51]{[48]} Mallotus phillipinesis is (Lam) Muell. Exhibited the most potent bactericidal activity against H.pylori which completely killed the bacteria at the concentration of 15.6-31.2 µg/ml. \hyperref[b17]{16} There is no evidence of in vivo effectiveness of this plant. Antibacterial activity of Allium sativum L(garlic) against H.pylori is well documented (40 µg/ml) and resistance has not been reported.The synergistic action of garlic and omeprazole against H.pylori was also reported.\par
Thiosulfinates play an important role in the antibiotic activity of garlic. Further clinical evaluation seems warranted. \hyperref[b52]{[49]}\hyperref[b53]{[50]}\hyperref[b54]{[51]} A mixture of tannic acid and n-propyl gallate can limit the gastric mucosa deterioration induced by H.pylori infection and vac A administration, suggest that vac A inhibition plays a role in this protective activity. So, polyphenols from plant sources may contribute to limit the pathological outcomes of H.pylori infection. \hyperref[b55]{52} Successive extracts of Sapindus mukorossi and Rheum emodi inhibited the growth of 30 resistant clinical isolates of H.pylori in vitro and in vivo studies and there was no acquired resistance against these herbal extracts even after ten consecutive passages. \hyperref[b56]{53} The evidence summarized above tentatively suggests possible benefits from some herbal sources with anti-Helicobacter pylori activity. Herbal science, Ayurvedic knowledge supported by modern science is required to standardize the plant extracts and to isolate, characterize and standardize the active constituents from plant sources for anti-Helicobacter pylori activity.\par
Extensive investigations and large scale well designed clinical trails are required to provide more conclusive proof to explore medicinal herbs for anti-Helicobacter pylori activity.\par
Table1 : Medicinal herbs having anti-Helicobacter pylori activity (global perspective).    
\section[{Global Journal of}]{Global Journal of}\begin{figure}[htbp]
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\caption{\label{fig_0}hydroxy- 4}\end{figure}
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\noindent\textbf{} \par 
\begin{longtable}{P{0.4604659248956884\textwidth}P{0.14895688456189152\textwidth}P{0.15073018080667594\textwidth}P{0.07093184979137691\textwidth}P{0.018915159944367176\textwidth}}
\multicolumn{4}{l}{Exploring Medicinal Plants for Anti-Helicobacter Pylori Activity}\tabcellsep \\
Botanical name\tabcellsep Source\tabcellsep Part used\tabcellsep Extract\tabcellsep Reference\\
South Asian Herbs\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Mallotus phillipinesis\tabcellsep Pakistan\tabcellsep covering fruit\tabcellsep Aqueous ethanol (70\%)\tabcellsep 16,17,18\\
Curcuma amada Roxb.\tabcellsep Pakistan\tabcellsep rhizome\tabcellsep \tabcellsep \\
Myristica fragrans Houtt.\tabcellsep Pakistan\tabcellsep seed\tabcellsep \tabcellsep \\
Psoralea corylifolia\tabcellsep Pakistan\tabcellsep seed\tabcellsep \tabcellsep \\
Glycyrrhiza glabra L\tabcellsep India,Srilanka\tabcellsep root\tabcellsep \tabcellsep \\
Terminalia chebula\tabcellsep Pakistan\tabcellsep fruit\tabcellsep \tabcellsep \\
Curcuma longa L\tabcellsep India\tabcellsep rhizome\tabcellsep \tabcellsep \\
Cuminum cyminum\tabcellsep Srilanka\tabcellsep seed\tabcellsep \tabcellsep \\
Coccinia grandis\tabcellsep India\tabcellsep leaves\tabcellsep Ethanol\tabcellsep \\
Terminalia arjuna\tabcellsep India\tabcellsep bark\tabcellsep Methanol\tabcellsep \\
East Asian Herbs\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Rhizoma coptidis\tabcellsep China\tabcellsep rhizome\tabcellsep Aqueous\tabcellsep 19,20\\
Radix scutellariae\tabcellsep China\tabcellsep root\tabcellsep \tabcellsep \\
Radix isatidis Asasarum sieboldi\tabcellsep China Korea\tabcellsep root root\tabcellsep Methanol\tabcellsep \\
Lindera strychifolia\tabcellsep Korea\tabcellsep root\tabcellsep \tabcellsep \\
Angelica tenuissima\tabcellsep Korea\tabcellsep root\tabcellsep \tabcellsep \\
Alpinia oxyphylla\tabcellsep Korea\tabcellsep fruit\tabcellsep \tabcellsep \\
American Herbs\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Zingiber officinale\tabcellsep USA\tabcellsep rhizome\tabcellsep Methanol\tabcellsep 21\\
Rosmarinus officinalis\tabcellsep USA\tabcellsep rosemary leaf\tabcellsep \tabcellsep \\
Foeniculum vulgare\tabcellsep USA\tabcellsep seed\tabcellsep \tabcellsep \\
Nigella sativa\tabcellsep USA\tabcellsep seed\tabcellsep \tabcellsep \\
African Herbs\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Terminalia spinosa\tabcellsep East Africa\tabcellsep young branches\tabcellsep Aqueous\tabcellsep 22\\
Harrisonia abyssinica\tabcellsep East Africa\tabcellsep root\tabcellsep \tabcellsep \\
Ximenia caffra\tabcellsep East Africa\tabcellsep root\tabcellsep \tabcellsep \\
Azadirachta indica\tabcellsep East Africa\tabcellsep leaves, stem bark\tabcellsep \tabcellsep \\
Combretum molle\tabcellsep South Africa\tabcellsep stem bark\tabcellsep Acetone\tabcellsep 23\\
Sclerocarya birrea\tabcellsep South Africa\tabcellsep stem bark\tabcellsep \tabcellsep \\
Carica papaya\tabcellsep Nigeria\tabcellsep leaf\tabcellsep Aqueous\& ethanol\tabcellsep 24\\
Morinda lucida\tabcellsep Nigeria\tabcellsep leaf\tabcellsep \tabcellsep \\
Octimum gratissimum Phyllanthus amarus\tabcellsep Nigeria Nigeria\tabcellsep leaf leaf\tabcellsep \tabcellsep \\
Brazelian Herbs\tabcellsep \tabcellsep \tabcellsep \tabcellsep \\
Bixa orellana L\tabcellsep Brazil\tabcellsep seed\tabcellsep Aqueous ethanol (96\%)\tabcellsep 25\\
Chamonilla recutita L\tabcellsep Brazil\tabcellsep inflorescence\tabcellsep \tabcellsep \\
Ilex paraguariensis A\tabcellsep Brazil\tabcellsep green leaves\tabcellsep \tabcellsep \\
Malva sylvestris L\tabcellsep Brazil\tabcellsep inflorescence \& leaves\tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_1}}\end{figure}
 \begin{figure}[htbp]
\noindent\textbf{2} \par 
\begin{longtable}{P{0.2770509977827051\textwidth}P{0.1319290465631929\textwidth}P{0.3637472283813747\textwidth}P{0.01696230598669623\textwidth}P{0.043348115299334807\textwidth}P{0.01696230598669623\textwidth}}
\tabcellsep \multicolumn{4}{l}{Exploring Medicinal Plants for Anti-Helicobacter Pylori Activity}\\
\multicolumn{2}{l}{Compound name}\tabcellsep Examples\tabcellsep \tabcellsep Mechanism of action\tabcellsep reference\\
Quinones\tabcellsep \tabcellsep \multicolumn{2}{l}{Quinones,idebenone,duroquinone,}\\
\tabcellsep \tabcellsep \multicolumn{2}{l}{menadione,juglone,coenzyme Q 1}\\
\multicolumn{2}{l}{Flavones, flavonoids}\tabcellsep \multicolumn{2}{l}{Quercetin, catechins, myristin, rutin}\\
and flavonols\tabcellsep \tabcellsep \tabcellsep \\
Phenolics\tabcellsep and\tabcellsep \multicolumn{2}{l}{Catechol, pyrogallol, curcumin}\\
polyphenols\tabcellsep \tabcellsep \tabcellsep \\
Tannins\tabcellsep \tabcellsep \multicolumn{3}{l}{Polymeric phenols, hydrolysable tannins}\\
\tabcellsep \tabcellsep 7-hydroxy-4-methyl\tabcellsep coumarin,\tabcellsep 6,7-\\
Coumarins\tabcellsep \tabcellsep \tabcellsep \\
Terpenoids\tabcellsep and\tabcellsep \tabcellsep \\
essential oils\tabcellsep \tabcellsep \tabcellsep \\
Alkaloids\tabcellsep \tabcellsep \tabcellsep \\
\multicolumn{2}{l}{Lectins and poly}\tabcellsep \tabcellsep \\
peptides\tabcellsep \tabcellsep \tabcellsep \end{longtable} \par
 
\caption{\label{tab_2}Table 2 :}\end{figure}
 			\footnote{© 2012 Global Journals Inc. (US)} 			\footnote{© 2012 Global Journals Inc. (US) © 2012 Global Journals Inc. (US)} 			\footnote{Exploring Medicinal Plants for Anti-Helicobacter Pylori Activity} 		 		\backmatter  			  				\begin{bibitemlist}{1}
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