Published online Feb 7, 2015. doi: 10.3748/wjg.v21.i5.1377
Peer-review started: November 4, 2014
First decision: November 14, 2014
Revised: November 24, 2014
Accepted: December 20, 2014
Article in press: December 22, 2014
Published online: February 7, 2015
Geographically the prevalence of duodenal ulceration is related to the staple foods in the diet in regions of developing countries where the diet is stable. It is higher in regions where the diet is based on milled rice, refined wheat or maize, yams, cassava, sweet potato, or green bananas, and is lower in regions where the staple diet is based on unrefined wheat or maize, soya, certain millets or certain pulses. Experiments on rat gastric and duodenal ulcer models showed that it was the lipid fraction in staple foods from low prevalence areas that was protective against both gastric and duodenal ulceration, including ulceration due to non-steroidal anti-inflammatory drugs (NSAIDs). It also promoted ulcer healing. The lipid from the pulse, Dolichos biflorus, horse gram which was highly protective was used to identify the fractions with protective activity in the lipid. The protective activity lay in the phospholipid, sterol and sterol ester fractions. In the phospholipid fraction phosphatidyl choline (lethicin) and phosphatidyl ethanolamine (cephalin) were predominant. In the sterol fraction the sub-fractions showing protective activity contained β-sitosterol, stigmasterol, and an unidentified isomer of β-sitosterol. The evidence from animal models shows that certain dietary phospholipids and phytosterols have a protective action against gastroduodenal ulceration, both singly and in combination. This supports the protective role of staple diets in areas of low duodenal ulcer prevalence and may prove to be of importance in the prevention and treatment of duodenal ulceration and management of recurrent ulcers. A combination of phospholipids and phytosterols could also play an important role in protection against ulceration due to NSAIDs.
Core tip: Geographically the prevalence of duodenal ulceration is low in regions where unrefined wheat or maize, certain millets and pulses and soya are staple foods. Experiments on rat gastric and duodenal ulcer models showed that the lipid fraction present in these staple foods was both protective against gastric and duodenal ulceration and also promoted ulcer healing. It was also protective against ulceration due to non-steroidal anti-inflammatory drugs. Further experiments showed that the protective activity lay in the phospholipid and sterol fractions present in the lipid fraction. These fractions were protective individually and in combination. The clinical application is discussed.