Preclinical Evidence of the Therapeutic Effect of Moringa oleifera in Peptic Ulcer Disease: A Systematic Review and Meta-Analysis

Saheed Olatunbosun Akiode¹Adeoti Gbemisola Adeniran²Oyedayo Phillips Akano³Kamoru Abdulazeez Adeniyi⁴Ayokunmi Stephen Olusa⁵Oghale Oghenefego Ovuakporie-Uvo^6*Uwaisu Iliyasu⁷Olunike Abodunrin^10,8,9Folahanmi Akinsolu^11,9Olajide Odunayo Sobande¹²

• ¹Biotechnology Advanced Research Centre, Sheda Science and Technology Complex (SHESTCO), P.M.B. 186, Garki, Abuja, Nigeria, Abuja, Nigeria
• ²Department of Physiology, University of Medical Sciences, Ondo, PMB 536, Laje Road, Ondo City, Ondo State, Nigeria., Ondo, Nigeria
• ³Department of Physiology, Faculty of Basic Medical Sciences, Olabisi Onabanjo University, Ago Iwoye, Ogun State, Nigeria., Ogun, Nigeria
• ⁴Department of Animal and Environmental Biology, Federal University Dutse, Jigawa State, Nigeria., Dutse, Nigeria
• ⁵Department of Pharmacology, Faculty of Pharmacy, Obafemi Awolowo University, Ile-Ife, Osun State, Nigeria., Ile-Ife, Nigeria
• ⁶Department of Science Laboratory Technology/Centre for Herbal Medicine and Drug Discovery, University of Medical Sciences, Ondo, Ondo, Nigeria
• ⁷Department of Pharmacognosy and Drug Development, Kaduna State University, Kaduna, Kaduna, Nigeria
• ⁸Department of Epidemiology and Biostatics, Nanjing Medical University, Nanjing 211166, China., Nanjing, China
• ⁹Center for Reproduction and Population Studies, Clinical Sciences Department, Nigerian Institute of Medical Research, Yaba, Lagos State., Lagos, Nigeria
• ¹⁰Department of Research, Capacity Building and Implementation, Alabastron Initiative, Lagos, Nigeria, Lagos, Nigeria
• ¹¹Department of Public Health, Faculty of Basic Medical and Health Sciences, Lead City University, Ibadan, Nigeria., Ibadan, Nigeria
• ¹²Nigerian Institute of Medical Research Foundation, Yaba. Lagos State., Lagos, Nigeria

Background: Peptic ulcer disease (PUD) remains a global health burden, with current therapies limited by recurrence, adverse effects, and high costs. Moringa oleifera, a medicinal plant traditionally used for gastrointestinal disorders, has shown anti-ulcer potential in several experimental models. However, no systematic synthesis has consolidated the available preclinical evidence. This review evaluated the therapeutic efficacy of M. oleifera in PUD using evidence from preclinical (rodent) studies. Materials and Methods: We searched PubMed, CINAHL, Scopus, Web of Science, and the Cochrane Library from inception (without time filter) to August 2025. Eligible studies were randomized controlled animal experiments assessing M. oleifera extracts in ulcer-induced models. Data on ulcer index were extracted, and a random-effects meta-analysis was performed using Hedge's g to calculate standardized mean differences (SMD). Heterogeneity was assessed with I², and publication bias with Egger's regression and trim-and-fill methods. Results: Eleven (11) studies involving 268 animals met the inclusion criteria, with SYRCLE quality scores ranging from 8 to 9. Pooled analysis showed that M. oleifera significantly reduced ulcer index compared with controls (SMD = –1.42; 95% CI: –2.01 to –0.83; p < 0.01). Subgroup analyses revealed variability by dose and comparator. High-dose comparisons with standard drugs showed no significant difference (SMD = –0.03; 95% CI: –0.27 to 0.66; p = 0.92; I² = 69%), while comparisons with basal controls also lacked significance (SMD = 0.99; 95% CI: 0.24 to 2.22; p = 0.11). Sensitivity analyses resolved heterogeneity (I² = 0%) and publication bias, without altering overall outcomes. Conclusion: Moringa oleifera demonstrates consistent gastroprotective and ulcer-healing effects in preclinical studies, though not always superior to standard therapies. Methodological heterogeneity and the absence of clinical trials highlight the need for standardized experimental protocols and translational research to establish its role as a potential adjunctive therapy for PUD. PROSPERO Reg. Number: CRD420251080346