Peptic Ulcer Disease: Mechanisms of Pathogenesis and Insights into Herbal versus Synthetic Treatments

Peptic ulcer disease remains a pressing health issue worldwide, most often linked to Helicobacter pylori infection and long-term use of non-steroidal anti-inflammatory drugs (NSAIDs). While conventional therapies such as proton pump inhibitors (PPIs), histamine-2 receptor antagonists (H2RAs), cytoprotective agents, and antibiotics have transformed patient care by reducing acid secretion and eradicating infection, they are not without drawbacks. Rising antibiotic resistance, drug-related side effects, and recurrence of ulcers continue to challenge clinicians and patients alike. In recent years, herbal medicine has gained attention as a complementary or alternative approach. Plant-derived compounds rich in flavonoids, tannins, alkaloids, and terpenoids offer anti-inflammatory, antioxidant, and antisecretory effects, while also strengthening the stomach’s natural defenses. Traditional remedies such as Anogeissus latifolia, Alchornea castaneaefolia, Decalepis salicifolia, Solanum nigrum, Ocimum tenuiflorum, Asparagus racemosus, and Curcuma longa have shown promising results in experimental models, not only reducing ulcer formation but also accelerating healing. This review brings together evidence on both synthetic and herbal strategies, comparing their mechanisms, effectiveness, safety, and cost considerations. While PPIs and antibiotic regimens remain indispensable for H. pylori eradication and NSAID-induced ulcer prevention, herbal therapeutics stand out for their lower side-effect profile and potential to provide long-term mucosal protection. Looking ahead, integrated treatment approaches that combine modern pharmacology with traditional phytomedicine may offer the most balanced and sustainable path for managing peptic ulcer disease.