Gastrointestinal Ulcers Treatment: Plants and Recipes Used by Herbalists of Abomey-Calavi and Cotonou Districts, Southern Benin

This study set out to identify plants and recipes used by herbalists in the municipalities of Abomey-Calavi and Cotonou to treat gastrointestinal ulcers and to characterize the distribution of their knowledge. An ethno-pharmacological survey was carried out in which informants who agreed freely were interviewed using a semi-structured questionnaire. A total of 85 herbalists were surveyed. The data were processed with Microsoft Excel to calculate the relative frequencies of citation of the various species mentioned by the herbalists and various indices including Simpson’s Index were adapted to test the distribution of their knowledge. Multiple regression and correspondence analysis were performed using R studio. Our results revealed that the Dendi, Ifè and Mina, all equitable in their knowledge of anti-ulcer plants, are likely to know more than the other ethnic groups. On the other hand, respondents practicing Islam are more likely to know many antiulcer plants than those practicing Vodoun and Christianity. This constant distribution of knowledge of anti-ulcer plants among the Dendi, Ifè and Mina, three different ethnic groups seems normal and attests to the fusion between these different ethnic groups in view of this knowledge. A total of 70 anti-ulcer recipes, made from 71 species of medicinal plants or non-floristic resources were recorded. Vitellaria paradoxa, Parkia biglobosa and Ocimum gratissimum were the top 03 most frequently cited in descending order of frequency. All the species cited are grouped into 44 botanical families among which the Fabaceae, Lamiaceae and Sapotaceae were strongly represented. Benin’s flora abounds in a diversity of medicinal plant species known to herbalists in Abomey-Calavi and Cotonou for the treatment of gastrointestinal ulcers. The results of this study constitute a good archive for the selection of plant species for in-depth studies with a view to formulating improved traditional medicines for gastrointestinal ulcers.

• Gastrointestinal Ulcer
• Ethnomedicine
• Herbalist
• Nature
• Plant Material

1. Introduction

Gastrointestinal ulcers are one of the major gastrointestinal pathologies affecting more than 10% of the world’s population each year [1] - [3] . It is a pathology frequently engendered by chronic consumption of alcoholic beverages, smoking, non-steroidal anti-inflammatory drugs, stress and H. pylori infection [4] . It may also be due to Salmonella enterica infection. Indeed, complications of typhoid or paratyphoid fever have led to cases of ulcer [5] [6] . While colonic ulcer due to Salmonella enteritidis infection is less common in children, a recent case was reported in a 32-month-old child [7] . In detail, infection with Salmonella enterica (Salmonella typhimurium, Salmonella paratyphi, and Salmonella enteritidis) causes gastric oxidative stress and disruption of gastrointestinal mucosal barriers, resulting in bleeding ulcerations [8] . Anticholinergics and antibiotic agents against ulcerogenic bacteria are the main classes of drugs used to treat this disease [9] .

However, the incidence of relapses and adverse effects generally associated with synthetic therapies cripple peptic ulcer control programs. By way of result, resistance to antibiotic therapy involved in the control of this pathology is a growing and persistent phenomenon as the deaths associated with bacterial AMR was estimated to be 4.95 million in 2019, including 1.27 million deaths attributable to bacterial AMR and the all-age death rate attributable to resistance was estimated to be highest in western sub-Saharan Africa, at 27.3 deaths per 100,000 [10] . H. pylori is one of the multidrug-resistant bacteria reported and resistance to clarithromycin, levofloxacin, and metronidazole has risen alarmingly [11] [12] . The WHO has classified Helicobacter pylori and Salmonella as priority pathogens for research and development of new antibiotics [13] [14] . In addition, studies have reported a high prevalence of Salmonella enterica multidrug resistance to antibiotics and resistance determinants that indicate an increased public health risk associated with Salmonella enterica infection [15] [16] . It is therefore urgent to find new molecules capable of replacing the anti-inflammatories, antioxidants, wound-healers and antimicrobials currently in use and failing, in particular those used to treat gastrointestinal ulcers. The therapeutic or dietary use of plant resources by anthropological groups has long provided a basis for the discovery of new active principles [17] . Herbal medicines continue to play an essential role in healthcare and their use by different cultures has been widely documented [18] [19] . The World Health Organization (WHO) estimated in 1985 that around 65% of the world’s population relied primarily on traditional plant-derived medicines for their primary health care [20] . Even thought, plants-based metabolites could play a crucial role in the treatment of H. pylori infections [21] .

The medicinal richness of African flora has been documented by several scientific studies. An ethnobotanical study conducted by Tesfaye et al. in Ethiopia identified 53 plant species belonging to 30 families traditionally used in cancer treatment, the most frequently mentioned being Acmella caulirhiza Del (Asteraceae), Clematis simensis Fresen (Ranunculaceae), Croton macrostachyus Del (Euphorbiaceae) and Dorstenia barnimiana Schweinf (Moraceae) [22] . The ethnopharmacology of cancer in Togo includes 70 plants from 39 families, the most frequently mentioned being Rubiaceae, Caesalpiniaceae, Fabaceae and Annonaceae, with the ten most frequently cited species being Xylopia aethiopica, Aframomum melegueta, Khaya senegalensis, Parkia biglobosa, Piliostigma thonningii, Blighia sapida, Vitellaria paradoxa, Adansonia digitata, Annona muricata and Parinari curatellifolia [23] . 14 plants commonly used and often endangered used by communities and traditional medical practitioners for treating sexually transmitted diseases from 5-selected districts of Zimbabwe were investigated for toxicity by Brine shrimp lethality test (BSLT), by 50% Cytopathic effect on VERO cultured cells, for antiviral activity and were found to be toxic and to have efficient antiviral activity [24] .

Benin, like other countries, boasts a wealth of ethno-medical resources. In particular, Akoegninou et al. listed nearly 30,700 specimens with therapeutic properties in Benin’s flora [25] . In the ethnobotanical study carried by Adomou et al., a total of 205 plant species used in the formulation of 41 recipes to treat 37 illnesses and symptoms, grouped into 181 genera and 74 families were identified [26] , the most represented families in terms of specific richness were Leguminosae, Rubiaceae and Euphorbiaceae. A recent study reported by Dougnon et al. identified 57 species sold by Beninese herbalists for the treatment of typhoid fever, including Senna siamea, Phyllantus amarus, Uvaria chamae, Vachellia sieberiana, Heterotis rotundifolia, Crateva adansonii, Citrus aurantiifolia, Acanthospermum hispidum, Corchorus olitorius [27] . There’s no doubt that Benin’s flora overflows in plants probably with anti-ulcer properties. To help meet the challenges posed by the ineffectiveness of the anti-ulcer molecules currently in use and the antimicrobial resistance of ulcer-causing bacteria, this study set out to explore the Beninese pharmacopoeia to identify and characterize plants and recipes used by the herbalists of Abomey-Calavi and Cotonou to treat gastrointestinal ulcers.

2. Materials and Methods

2.1. Study Area

This study was carried out in the communes of Abomey-Calavi ( Figure 1 ) and Cotonou ( Figure 2 ) from April to May 2022, both in southern Benin. This region is characterized by strong ethnic and culture diversity. Indeed, each people has its own relationship with its animal and plant environment, which it exploits to satisfy its basic needs, particularly health [28] .

Southern Benin lies between 6˚25'N and 7˚30'N and covers an area of 17.109 km². Its climate is sub-equatorial and characterized by a bimodal rainfall regime with two rainy seasons alternating with two dry seasons. The average annual temperature is 28˚C and air humidity varies between 69% and 97%. Ferralitic soils on clayey sediments, hydromorphic soils in valleys, lowlands and alluvial plains, Vertisols in the Lama depression and tropical eutrophic brown soils are found. Its vegetation comprises a mosaic of dense rainforest islands, savannahs, grasslands, mangroves and fallows. The total flora of southern Benin comprises 1170 plant species [26] . The dominant ethnic groups are Fon and related cultures (39.2%), Adja and related cultures (15.2%) and Yoruba and related cultures (14.5%) [29] [30] .

2.2. Data Collection

To carry out the ethno-pharmacological survey, we explained the purpose of our study to herbalists and sought their consent to the capitalization of their

Figure 1

Figure 1. Abomey-Calavi municipality map.

Figure 2

Figure 2. Cotonou municipality map.

knowledge in a published document in order to avoid the erosion of knowledge about medicinal plants used for ulcer treatment as used by Yetein et al. [31]. The informants were identified by snow ball sampling method and those who freely agreed to participate in our study were selected and interviewed using a semi-structured questionnaire. A total of 85 herbalists were surveyed. This survey enabled us to collect data from herbalists on the phytopharmaceutical resources used for ulcer treatment.

2.3. Statistical Analysis

Survey data were compiled in Excel spreadsheets and then visualized. Data pre-processing consisted to match and confirm vernacular and common names provided by herbalists to corresponding scientific names. The names of cited plants were matched with local, vernacular, vulgar and scientific names from research reported by Akoegninou et al. and also recent research published [25] - [27] . The data were then processed using the Microsoft Excel package’s using pivot table function to calculate the absolute and relative citations frequencies of the different species mentioned by the herbalists.

The Sympson index used by Guillaume was specifically adopted and used to measure the homogeneous or non-homogeneous nature of the distribution of anti-ulcer plant knowledge, and is calculated by the formula (1) [32] .

$\lambda ={\displaystyle \underset{i=1}{\overset{s}{\sum }}{\left(P_i\right)}^2}$(1)

where, P_i = proportion of citations for species i (2), S = total or cardinal number of species cited.

$P_i=\frac{n_i}{N}$(2)

where, n_i = number of citations of species I, N = total number of citations. The closer this index is to 1, the more evenly distributed the knowledge is.

The Diversity index (3) and the Equitability index (4), were calculated to measure respectively the diversity of plant species cited and the dominance of plants cited.

$D=1-\lambda$(3)

where, λ = Index of Sympson, D = 1: Case where an infinite number of species are cited. Probability approximately equal to zero: Case where very few species are cited.

$ED=D/D_{\max }$(4)

where, D = Diversity of citation, D_max = maximal Diversity. Simpson’s equitability index is used to express the dominance of one species (ED tends towards 0) or the codominance of several species (ED tends to-wards 1).

In addition. the data were subjected to multivariate statistical analysis. including multiple regression and factorial correspondence analysis.

3. Results

3.1. Characteristics of the Herbalists Prospected

Figure 1 shows the socio-demographic characteristics of the survey population. This includes information on ethnicity, religion, education level and seniority.

The populations surveyed are made up of 50%, 14.28%, 10.71%, 7.14%, 3.57%, 3.57%, 3.57%, 3.57%, 3.57% respectively Fon, Aizo, Mina, Goun, Dendi, Hloua, Houagonou, Ifè and Mahi ( Figure 3(a) ). Even if other ethnic groups are represented, it is clear that the herbalists surveyed in this study are dominated by fons speakers. We recorded the representation of Christianity, Vodoun and Islam ( Figure 3(b) ). In fact, 71.42% of the herbalists surveyed were Christians, 25% were followers of Vodoun and 3.57% were Muslims. It should be noted that the majority of herbalists surveyed were Christians. The herbalists surveyed are categorized into three levels of education: primary, secondary and higher ( Figure 3(c) ). The primary education was the most represented with 82.75%, followed by the secondary level with 13.79% and the higher level with 3.44%.

Herbalists’ seniority was represented in four ranges: [1;10[, [10;20[, [20;30[ and [30;40] ( Figure 3(d) ). The [20;30[ seniority was the most representative with 32.14%. It is followed by the [1;10[ and [10;20[ each with a percentage of 25%. In addition, 17.85% of herbalists have exerted the profession since 30 to 40 years.

Figure 3

Figure 3. Characteristics of informants.

3.2. Distribution of Knowledge on Plant Used for Treatment of Gastrointestinal Ulcer

The parameters of repartition on plant used for treatment of gastrointestinal ulcer are summarized in Table 1 and Table 2 . The interviewee diversity index calculated shows that Dendi (0.0697), Ifè (0.0697) and Mina (0.0593) ethnic groups are susceptible to knowing more antiulcer plants than the other ethnic groups. In addition. The Equitability Index was evaluated for the populations surveyed, where the averages by ethnic group are summarized in. A comparison of the equitability index between ethnic groups shows that the Dendi (0.8991), Ifè (0.8991) and Mina (0.7657) groups have equal knowledge of anti-ulcer plants. The same statement applies to the Aizonnou, Fon, Goun and Mahi ethnics groups.

We also note that respondents practicing Islam are more likely to know many anti-ulcer plants than those practicing Vodou and Christianity. We also note from the comparison of the average equitability index of religious groups that respondents practicing Vodou and those practicing Christianity tend to have the same level of knowledge of anti-ulcer plants. All these explanations are confirmed by correspondence analysis summarized in Figure 4 , where ethnic and religious groups are defined by their level of knowledge of anti-ulcer plants. However, the multiple regression analysis performed has demonstrated that none of ethnicity, education and religion whether or not combined did not predict the distribution of knowledge on plants used to treat gastro-intestinal ulcer ( Table 3 ).

Table 1

Table 1. Distribution of ethnic groups represented according to average diversity and equitability indices.

Ethnic Group	Average Diversity index (ID = Ex/Et)	Equitability index (IE = ID/IDmax)
Aizonnou	0.0271	0.3498
Dendi	0.0697	0.8991
Fon	0.0320	0.4128
Goun	0.0232	0.2992
Hloua	0.0077	0.0993
Houagonou	0.0155	0.1999
Ifè	0.0697	0.8991
Mahi	0.0232	0.2992
Mina	0.0593	0.7657

Table 2

Table 2. Average diversity and equitability indexes defined by religious groups.

Religious group	Average Diversity index (ID = Ex/Et)	Equitability index (IE = ID/IDmax)
Christianism	0.0356	0.4594
Vodoun	0.0271	0.3495
Islam	0.0697	0.8991

Figure 4

Figure 4. Projection of ethnic and religious groups defined by knowledge of anti-ulcer plants.

Table 3

Table 3. Multiple regression of the distribution of antiulcer plant knowledge according to ethnicity, level of education and/or religion.

Model	Multiple R-squared	Adjusted R-squared	F-statistic	p-value
Ethnicity + Education + Religion	0.03925	−0.07604	0.3404	0.7963
Ethnicity + Education	0.0354	−0.0388	0.4771	0.6259
Ethnicity	0.003141	−0.03378	0.08508	0.7728
Education	0.03456	−0.001193	0.9666	0.3343
Religion	0.001089	−0.03591	0.02944	0.8651
Education + Religion	0.03902	−0.0349	0.5279	0.596
Ethnicity + Religion	0.005628	−0.07086	0.07357	0.9293

3.3. Plants Used by Herbalists in the Municipalities of Abomey-Calavi and Cotonou to Treat Gastrointestinal Ulcers

Table 5 shows the plant species of the Benin pharmacopoeia used by herbalists in the municipalities of Abomey-Calavi and Cotonou for the treatment of gastrointestinal ulcers. A total of 71 species were inventoried, among which the 12 most frequently cited, in decreasing order of frequency, were Vitellaria paradoxa, Parkia biglobosa, Ocimum gratissimum, Khaya senegalensis, Citrus limon, ACACIA nilotica ou adansonii, Ocimum canum, Phyllanthus amarus, Senna siamea, Piper guineense, Momordica charantia, Pteleopsis suberosa, Spondias mombin, Sida acuta, Jatropha multifida, Heliotropium indicum, Eugenia aromatica and Crateva adansonii. With a fair citation frequency (3.57%) and a fair probability of occurrence (0.01), 26 of the species cited for the treatment of gastrointestinal ulcers are less represented. These include: Anchomanes difformis, Anacardium occidentale, Catharanthus roseus, Combretum micranthum, Rhaphiostylis beninensis, Xylopia aethiopica, Sansevieria liberica, Hyptis suaveolens, Pseudocedrela kotschyi, Rauvolfia vomitoria Afzel, Cassytha filiformis, Alium cepa, Newbouidia leavis, Rourea coccinea, Alchornea cordifolia, Combretum racemosum, Eucalyptus globulus (Eucalyptus radiata), Zanthoxylum zanthoxyloïdes (Lam. ), Rytigynia umbellulate, Carissa spinarum, Cajanus cajan, Passiflora foetida, Ceratotheca sesamoides, Bridelia ferruginea Benth, Terminalia glaucescens and Carica papaya.

All the cited species are grouped into 44 taxonomic families, as shown in Table 6 . In ascending order of frequency, Fabaceae, Lamiaceae, Sapotaceae, Euphorbiaceae, Rutaceae, Annonaceae, Meliaceae, Malvaceae, Combretaceae and Boraginaceae were the ten firstly most represented families.

The various species cited for the treatment of gastrointestinal ulcers are heterogeneously distributed as confirmed by the Simpson Index evaluated (ʎ = 0.163), which is inferior to 1 ( Table 4 ). Furthermore, the calculated Diversity Index is D = 0.837, a value very close to 1, indicating a large number of species with very low probabilities ( Table 4 ). In addition, the Simpson Equitability Index (ED) was evaluated to determine the degree of equality of the species listed. Its value ED = 0.849, very close to 1, indicates the codominance of several listed species ( Table 4 ). This codominance is noted with Vitellaria paradoxa, Parkia biglobosa and Ocimum gratissimum and Khaya senegalensis, Citrus limon, Acacia nilotica or adansonii, Ocimum canum, Phyllanthus amarus and Senna siamea. The equality of frequency and probability noted for some of the species mentioned also accounts for this codominance ( Table 5 ).

Table 4

Table 4. Indices of anti-ulcer plant distribution.

Species diversity index	Valeurs
Simpson index (ʎ)	0.163
Diversity Index (D)	0.837
Maximum diversity (Dmax)	0.985
Equitability Index (EI)	0.849

3.4. Characterization of Recipes Listed by Herbalists for the Treatment of Gastrointestinal Ulcer

The various recipes given by herbalists for the treatment of gastrointestinal ulcers are listed in Table 7 . A total of 70 anti-ulcer recipes made from medicinal plants (leaves, stems, seeds, fruits, barks, whole plants, flowers and/or roots) and/or non-wood resources such as peak milk, white calaba and honey (recipes 7, 13, 14, 23 and 28) were given by the herbalists surveyed. On average, they consisted of 3 ± 2 phytopharmaceutical resources. Three of the recipes are made up of the largest number of phytopharmaceutical resources, i.e. recipes N˚8, 11 and 21. The 8th recipe is made up of 9 resources, including Acacia nilotica or adansonii, Momordica charantia L., Phyllanthus amarus, Ocimum gratissimum L., Lantana camara, Hyptis suaveolens, Piper guineense, Allium sativum and Piper guineense; the 11th recipe is made up of 10 resources including Tetrapleura tetraptera, Xylopia aethiopica, Acacia nilotica or adansonii, Spondias mombin, Alchornea cordifolia, Piper guineense, Eugenia aromatica, Khaya senegalensis, Pteleopsis suberosa, and Saba senegalensis, then the 21st recipe is made up of 11 resources including Eugenia aromatica, Xylopia aethiopica, Monodora myristica, Tetrapleura tetraptera, Momordica charantia, Clausena anisata, Caesalpinia pucherrima, Ocimum gratissimum L., Khaya senegalensis, Jatropha multifida, and Piper guineense. Although the majority of recipes are used by decoction, some of them are used by maceration, infusion, crushing or pulverization. Most of the recipes given have no contraindications. However, some of them prohibit the consumption of certain foods during treatment. These are recipes 13 (Consumption of raw meat, gari and galette), 24 (Consumption of spicy, hot meals and gari), 38 (Consumption of spicy and fermented meals), 51 (Consumption of milk and gari) and 57 (Consumption of cold meals, sweet drinks and fruit).

Table 5

Table 5. Plants used to treat gastrointestinal ulcers.

N°	Scientific names	Family	Local names	Citation Frequence	Proportional abundance (Pi)	(Pi)²
1	Vitellaria paradoxa	Sapotaceae	Limi	46.42	0.18	0.0324
2	Parkia biglobosa	Fabaceae	Aha	39.28	0.15	0.0225
3	Ocimum gratissimum L.	Lamiaceae	Tchiayo	35.71	0.14	0.0196
4	Khaya senegalensis	Meliaceae	Zounza; Kaïlcédra	25	0.1	0.01
5	Citrus limon	Rutaceae	cle	25	0.1	0.01
6	ACACIA nilotica ou adansonii	Fabaceae	Nep nep/Bani	21.42	0.08	0.0064
7	Ocimum canum	Lamiaceae	Késsoukéssou	21.42	0.08	0.0064
8	Phyllanthus amarus	Euphorbiaceae	Hlenwé	21.42	0.08	0.0064
9	Senna siamea	Fabaceae	Acasia	17.85	0.07	0.0049
10	Piper guineense	Piperaceae	Linlinku	14.28	0.05	0.0025
11	Momordica charantia L.	Cucurbitaceae	Nyèsiken; Nyinya	14.28	0.05	0.0025
12	Pteleopsis suberosa	Combretaceae	kuilikuili	14.28	0.05	0.0025
13	Spondias mombin	Anacardiaceae	Agnougloétin ; Sam	14.28	0.05	0.0025
14	Sida acuta	Malvaceae	Azatalouga (Adonma)	14.28	0.05	0.0025
15	Jatropha multifida	Euphorbiaceae	tanti doto	14.28	0.05	0.0025
16	Heliotropium indicum	Boraginaceae	Kokloden	14.28	0.05	0.0025
17	Eugenia aromatica	Myrtaceae	Atikingbadota	14.28	0.05	0.0025
18	Crateva adansonii	Capparaceae	Wontonzouinzouin	14.28	0.05	0.0025
19	Monodora myristica	Annonaceae	Sasaliku	10.71	0.04	0.0016
20	Xylopia aethiopica	Annonaceae	Kpédjréku	10.71	0.04	0.0016
21	Cola millenii	Malvaceae	Aloviaton	10.71	0.04	0.0016
22	Kigelia africana	Bignoniaceae	Gnanblikpo	10.71	0.04	0.0016
23	Capsicum frutescens	Solanaceae	Danmè takin	10.71	0.04	0.0016
24	Vernonia cinerea (L.) Less. (Cyanthilium cinereum (L)	Asteraceae	Houinssikoussè; Hussikonou	10.71	0.04	0.0016
25	Dichapetalum madagascariense (DC.)	Dichapetalaceae	Gbaglo	10.71	0.04	0.0016
26	Cocos nucifera	Arecaceae	Agonkètin	10.71	0.04	0.0016
27	Chenopodium ambrosioides	Chenopodiaceae	Amantrouzu/Gogo	10.71	0.04	0.0016
28	Tetrapleura tetraptera	Fabaceae	Linja	10.71	0.04	0.0016
29	Bambusa vulgaris Schrad ex. Wendel	Poaceae	Dawé	10.71	0.04	0.0016
30	Persea americana	Lauraceae	Avoca ma	7.14	0.02	0.0004
31	Cymbopogon citratus	Poaceae	Tea ma	7.14	0.02	0.0004
32	Ehretia cymosa Thonn	Boraginaceae	Mignonman	7.14	0.02	0.0004
33	Clausena anisata	Rutaceae	Gbossoazohion	7.14	0.02	0.0004
34	Acanthospermum hispidum DC.	Asteraceae	Ahouanglon	7.14	0.02	0.0004
35	Annona muricata	Annonaceae	Chap-chap	7.14	0.02	0.0004
36	Corchorus olitorius L	Malvaceae	Ninouwi	7.14	0.02	0.0004
37	Pupalia lappacea ou Achyranthes lappacea L. ou Pupal lappacea (L.)	Amaranthaceae	Trèdoavohou; Trèdagboko; Tètèmatè	7.14	0.02	0.0004
38	Lippia multiflora	Verbenaceae	Agalala	7.14	0.02	0.0004
39	Caesalpinia pucherrima	Fabaceae	Orgueil de chine	7.14	0.02	0.0004
40	Allium sativum	Amaryllidaceae	Ayo	7.14	0.02	0.0004
41	Lantana camara	Verbenaceae	Hlachiayo	7.14	0.02	0.0004
42	Erythrina senegalensis	Kpakléssi	Kpakéssi	7.14	0.02	0.0004
43	Maranthes polyandra (Benth.)	Chrysobalanaceae	Magbèvidé	7.14	0.02	0.0004
44	Cissus quadrangularis	Vitaceae	Asan. Kankpe. Alinkpe. Avounga	7.14	0.02	0.0004
45	Anchomanes difformis	Araceae	Godoe	3.57	0.01	0.0001
46	Anacardium occidentale	Anacardiaceae	Cajou	3.57	0.01	0.0001
47	Catharanthus roseus	Apocynaceae	Bonjourbonsoir	3.57	0.01	0.0001
48	Combretum micranthum	Combretaceae	Kinkéliba	3.57	0.01	0.0001
49	Rhaphiostylis beninensis	Metteniusaceae	Kplakplakan	3.57	0.01	0.0001
50	Xylopia aethiopica	Annonaceae	Wakonto	3.57	0.01	0.0001
51	Sansevieria liberica	Agavaceae	Kpognando	3.57	0.01	0.0001
52	Hyptis suaveolens	Lamiaceae	Zansoukpema; Afio	3.57	0.01	0.0001
53	Pseudocedrela kotschyi	Meliaceae	Atidohoukpédo	3.57	0.01	0.0001
54	Rauvolfia vomitoria Afzel	Apocynaceae	Lèwédo	3.57	0.01	0.0001
55	Cassytha filiformis	Lauraceae	Agbégbékan	3.57	0.01	0.0001
56	Alium cepa	Amaryllidaceae	Ayoma vovo	3.57	0.01	0.0001
57	Newbouidia leavis	Bignoniaceae	Désré	3.57	0.01	0.0001
58	Rourea coccinea	Connaraceae	Vikplomba	3.57	0.01	0.0001
59	Alchornea cordifolia	Euphorbiaceae	Djéka (Dioulas); Klan Madou (g)	3.57	0.01	0.0001
60	Combretum racemosum	Combretaceae	Wèdo	3.57	0.01	0.0001
61	Eucalyptus globulus; Eucalyptus radiata	Myrtaceae	Eucalyptus	3.57	0.01	0.0001
62	Zanthoxylum zanthoxyloïdes (Lam.)	Rutaceae	Hêdo	3.57	0.01	0.0001
63	Rytigynia umbellulata	Rubiaceae	Gbadéman	3.57	0.01	0.0001
64	Carissa spinarum	Apocynaceae	Ahanzodo	3.57	0.01	0.0001
65	Cajanus cajan	Fabaceae	Klouékou ma	3.57	0.01	0.0001
66	Passiflora foetida	Passifloraceae	Avoun didouè	3.57	0.01	0.0001
67	Ceratotheca sesamoides Endl	Pedaliaceae	Agbo	3.57	0.01	0.0001
68	Bridelia ferruginea Benth.	Phyllanthaceae	Housoukokwé	3.57	0.01	0.0001
69	Terminalia glaucescens	Combretaceae	Anagoitin do	3.57	0.01	0.0001
70	Carica papaya	Caricaceae	kpin assou	3.57	0.01	0.0001
71	Gardenia erubescens Stapf & Huteh	Rubiaceae	Adakplaman/Hêmandjè	3.57	0.01	0.0001

Table 6

Table 6. Distribution of different species families.

N°	Family	Frequences
1	Fabaceae	52.27
2	Lamiaceae	38.63
3	Sapotaceae	29.54
4	Euphorbiaceae	22.72
5	Rutaceae	20.45
6	Annonaceae	20.45
7	Meliaceae	18.18
8	Malvaceae	15.9
9	Combretaceae	15.9
10	Boraginaceae	13.63
11	Poaceae	11.36
12	Myrtaceae	11.36
13	Asteraceae	11.36
14	Anacardiaceae	11.36
15	Fabaceae	11.36
16	Vitaceae	9.09
17	Bignoniaceae	9.09
18	Piperaceae	9.09
19	Capparaceae	9.09
20	Verbenaceae	9.09
21	Cucurbitaceae	9.09
22	Apocynaceae	6.81
23	Dichapetalaceae	6.81
24	Solanaceae	6.81
25	Arecaceae	6.81
26	Chenopodiaceae	6.81
27	Lauraceae	6.81
28	Chrysobalanaceae	4.54
29	Malvaceae	4.54
30	Amaryllidaceae	4.54
31	Amaranthaceae	4.54
32	Kpakléssi	4.54
33	Metteniusaceae	2.27
34	Euphorbiaceae	2.27
35	Araceae	2.27
36	Amaryllidaceae	2.27
37	Rubiaceae	2.27
38	Agavaceae	2.27
39	Caricaceae	2.27
40	Phyllanthaceae	2.27
41	Passifloraceae	2.27
42	Pedaliaceae	2.27
43	Rutaceae	2.27
44	Connaraceae	2.27

Table 7

Table 7. Recipes listed by herbalists for anti-ulcer plants.

N°	Number of plants	Recipe compositions	Parts used		Forms of use		Sides effects
1	5	Eucalyptus globulus; Eucalyptus radiata	Stem bark		Decoction		N/A
		Eugenia aromatica	Dry flower
		Xylopia aethiopica	Seeds
		Monodora myristica	Seeds
		Acacia nilotica adansonii	Seeds
2	3	Spondias mombin	Leaves		Decoction		N/A
		Citrus limon	Leaves
		Jatropha multifida	Leaves
3	6	Acacia nilotica adansonii	Seeds		Decoction				N/A
3	6	Carissa spinarum		Stems		Decoction			N/A
		Anchomanes difformis		Leaves
		Ocimum canum		Leaves
		Ocimum gratissimum L.		Leaves
		Tetrapleura tetraptera		Seeds
4	3	Ocimum gratissimum L.		Leaves		Decoction			N/A
		Lantana camara		Leaves
		Piper guineense		Seeds
5	6	Ocimum gratissimum L.		Leaves		Decoction			N/A
		Passiflora foetida		Leaves
		Rhaphiostylis beninensis		Leaves and Stems
		Kigelia africana		Fruits
		Parkia biglobosa		Stem bark
		Clausena anisata		Roots
6	2	Phyllanthus amarus		Leaves		Decoction			N/A
		Momordica charantia L.		Leaves and Stems
7	1	Zea mays		Fresh Seeds		Piling			N/A
		Peak milk		N/A
8	9	Acacia ilotica ou adansonii		Seeds		Decoction			N/A
		Momordica charantia L.		Leaves and Stems
		9Phyllanthus amarus		Leaves and Stems
		Ocimum gratissimum L.		Leaves and Stems
		Lantana camara		Leaves and Stems
		Hyptis suaveolens		Leaves and Stems
		Piper guineense		Seeds
		Allium sativum		Pods
		Piper guineense		Seeds
9	5	Khaya senegalensis		Stem bark		Decoction			N/A
		Terminalia glaucescens		Roots
		Pseudocedrela kotschyi		Roots
		Combretum racemosum		Roots
		Caesalpinia pucherrima		Roots
10	4	Parkia biglobosa		Stem bark		Decoction			N/A
		Pteleopsis suberosa		Stem bark
10	4	Maranthes polyandra		Leaves		Decoction			N/A
		Ocimum canum		Leaves and Stems
11	10	Tetrapleura tetraptera		Fruits		Decoction			N/A
		Xylopia aethiopica		Seeds
		Acacia nilotica adansonii		Seeds
		Spondias mombin		Leaves
		Alchornea cordifolia		Leaves
		Piper guineense		Seeds
		Eugenia aromatica		Seeds
		Khaya senegalensis		Stem bark
		Pteleopsis suberosa		Stem bark
		Saba senegalensis (A. DC.) Pichon		Stem bark
12	3	Ocimum gratissimum L.		Leaves and Stems		Decoction			N/A
		Heliotropium indicum		Leaves and Stems
		Acanthospermum hispidum DC.		Leaves
13	1	Vitellaria paradoxa		Stem bark		Piling			Avoid raw meats, Gari and galette
		Calaba blanc		N/A
		Honney bee		N/A
14	2	Khaya senegalensis		Stem bark		Piling			N/A
		Honney bee		Honey
15	3	Spondias mombin		Leaves		Decoction			N/A
		Citrus limon		Leaves
		Jatropha multifida		Leaves
16	2	Jatropha multifida		Leaves		Decoction			N/A
		Vitellaria paradoxa		Stem bark
17	2	Phyllanthus amarus		Leaves and Stems		Decoction			N/A
		Khaya senegalensis		Stem bark
18	7	Pteleopsis suberosa		Stem bark		Decoction		N/A
		Parkia biglobosa		Stem bark
		Vitellaria paradoxa		Stem bark
		Bridelia ferruginea Benth.		Stem bark
		Monodora myristica		Seeds
		Acacia nilotica adansonii		Seeds
		Xylopia aethiopica		Seeds
19	1	Vitellaria paradoxa		Stem bark		Piling		N/A
20	2	Cocos nucifera		Juice from unripe fruit		Piling		N/A
		Pupalia lappacea ou Achyranthes lappacea L. ou Pupal lappacea (L.)		Leaves
21	11	Eugenia aromatica		Fruit		Decoction		N/A
		Xylopia aethiopica		Seeds
		Monodora myristica		Seeds
		Tetrapleura tetraptera		Fruit
		Momordica charantia L.		Leaves
		Clausena anisata		Leaves
		Caesalpinia pucherrima		Roots
		Ocimum gratissimum L.		Leaves and stems
		Khaya senegalensis		Stem bark
		Jatropha multifida		Leaves
		Piper guineense		Seeds
22	1	Vitellaria paradoxa		Stem bark		Decoction		N/A
23	1	Calaba blanc		N/A		Piling		N/A
		Cassytha filiformis		Leaves and stem
24	5	Pteleopsis suberosa		Stem bark		Decoction		Chilli pepper, hot meal, gari
		Vitellaria paradoxa		Stem bark
		Parkia biglobosa		Stem bark
		Khaya senegalensis		Stem bark
		Lippia multiflora		Leaves and stem
25	1	Vernonia cinerea (L.) Less. (Cyanthilium cinereum (L) H.Rob)		Leaves and stem		Decoction		N/A
	8	Spondias mombin		Roots, Leaves and stem		Decoction		N/A
		Parkia biglobosa		Stem bark
		Chenopodium ambrosioides		Leaves
26		Bambusa vulgaris Schrad ex. Wendel		Leaves
		Ocimum gratissimum L.		Leaves
		Ocimum canum		Leaves
		Heliotropium indicum		Leaves
		Ehretia cymosa Thonn		Leaves
27	2	Vitellaria paradoxa		Stem bark		Decoction		N/A
		Parkia biglobosa		Stem bark
28	0	Calaba blanc		N/A		Piling		N/A
		Lait peak		N/A
29	1	Persea americana		Leaves		Decoction		N/A
30	3	Ocimum canum		Leaves and stem		Decoction		N/A
		Crateva adansonii		Leaves
		Dichapetalum madagascariense (DC.) Keay		Leaves
31	1	Pupalia lappacea ou Achyranthes lappacea L. ou Pupal lappacea (L.)		Leaves		Piling		N/A
		Calaba blanc		N/A
32	5	Ocimum gratissimum L.		Leaves		Decoction		N/A
		Momordica charantia L.		Leaves
		Chenopodium ambrosioides		Roots
		Jatropha multifida		Leaves
		Crataeva adansoniiDC		Leaves
33	4	Parkia biglobosa		Stem bark		Decoction		N/A
		Pteleopsis suberosa		Stem bark
		Maranthes polyandra (Benth.), Prance		Leaves
		Ocimum canum		Leaves
34	1	Parkia biglobosa		Stem bark		Decoction		N/A
35	2	Vitellaria paradoxa		Stem bark		Decoction		N/A
		Lippia multiflora		Leaves and stem
36	3	Vitellaria paradoxa		Stem bark		Decoction		N/A
		Lippia multiflora		Leaves and stem
		Justicia secunda Vahl		Flowers
37	1	Jatropha multifida		Leaves		Decoction		N/A
38	1	Kigelia africana		Fruits		Maceration		Avoid spicy or fermented foods
39	1	Rourea coccinea		Leaves		Piling		N/A
40	2	Jatropha multifida		Leaves and Roots		Decoction		N/A
		Catharanthus roseus		Whole plant or leaves
41	3	Ocimum canum		Leaves		Decoction		N/A
		Dichapetalum madagascariense (DC.) Keay		Leaves
		Crateva adansonii		Leaves
42	4	Parkia biglobosa		Stem bark				N/A
42	4	Lantana camara		Leaves				N/A
		Erythrina senegalensis		Leaves
		Carica papaya		Flowers, Leaves and Roots
43	1	Sida acuta		Whole plant		Decoction		N/A
44	6	Zanthoxylum zanthoxyloïdes (Lam.) Zepern. & Timler		Roots		Decoction		N/A
		Kigelia africana		Fruit
		Rauvolfia vomitoria Afzel		Roots
		Heliotropium indicum		Leaves
		Newbouidia leavis		Stem bark and Roots
		Parkia biglobosa		Stem bark
45	1	Khaya senegalensis		Leaves, Roots, Stem bark		Decoction		N/A
46	3	Sida acuta		Leaves and stem		Decoction		N/A
		Corchorus olitorius L		Laves and stem
		Citrus limon		Fruits
47	4	Senna siamea		Roots, Leaves, Stem bark		Decoction		N/A
		Ocimum gratissimum L.		Leaves
		Capsicum frutescens		Seeds
		Cymbopogon citratus		Leaves
48	4	Spondias mombin		Leaves		Decoction		N/A
		Persea americana		Leaves
		Citrus limon		Leaves
		Cymbopogon citratus		Leaves
49	2	Corchorus olitorius L		Leaves and stem		Decoction		N/A
		Citrus limon		Fruits
50	2	Senna siamea		Leaves and stem		Decoction		N/A
		Sida acuta		Leaves
51	2	Anacardium occidentale		Stem bark		Decoction		Milk, gari
		Vitellaria paradoxa		Stem bark
52	1	Phyllanthus amarus		Whole plant		Infusion		N/A
53	2	Sansevieria liberica		Leaves		Decoction		N/A
		Citrus limon		Leaves
54	2	Senna siamea		Leaves, Stem and Roots		Decoction		N/A
		Capsicum frutescens		7 fruit for woman and 9 for man
55	1	Senna siamea		Leaves, Stem bark, Roots		Decoction		N/A
56	2	Phyllanthus amarus		Whole plant		Decoction		N/A
		Eugenia aromatica		Flowers
57	2	Bambusa vulgaris Schrad ex. Wendel		Leaves		Decoction		Cold meal, soft drink, fruit
		Vitellaria paradoxa		Leaves
58	2	Sida acuta		Whole plant		Decoction		N/A
		Citrus limon		Fruits
59	5	Dichapetalum madagascariense (DC.) Keay		Leaves		Decoction		N/A
		Combretum micranthum		Leaves
		Acanthospermum hispidum DC.		Leaves
		Cissus quadrangularis		Leaves
		Capsicum frutescens		Fruits
60	4	Crateva adansonii		Leaves		Decoction		N/A
		Vitellaria paradoxa		Stem bark
		Gardenia erubescens Stapf & Huteh		Leaves
		Erythrina senegalensis		Leaves
61	2	Ceratotheca sesamoides Endl		Leaves		Decoction		N/A
		Citrus limon		Leaves
62	1	Alium cepa		Pods		Piling		N/A
63	2	Acanthospermum hispidum DC.		Whole plant		Decoction		N/A
		Citrus limon		Fruits
64	2	Corchorus olitorius L		Whole plant		Decoction		N/A
		Vitellaria paradoxa		Fruit
65	2	Dichapetalum madagascariense (DC.) Keay		Leaves		Decoction		N/A
		Cissus quadrangularis		Leaves
66	1	Chap chap		Leaves		Decoction		N/A
67	1	Bambusa vulgaris Schrad ex. Wendel		Leaves		Decoction		N/A
68	2	Citrus decumana		Fruits		Decoction		N/A
		Moringa oleifera Lam		Leaves
69	2	Corchorus olitorius L		Whole plant		Decoction		N/A
		Parkia biglobosa		Stem bark
70	2	Cajanus cajan		Leaves		Decoction		N/A
		Vitellaria paradoxa		Stem bark

N/A: Not Applicable.

4. Discussion

The importance of medicinal plants became evident for all as WHO listed 21,000 plants which are extensively used for therapeutic purposes throughout the world [33] . They are known to contain Phytochemicals classified as primary (e.g. carbohydrates, lipids, amino acid derivations, etc.) or secondary (e.g. alkaloids, terpenes and terpenoids, phenolic compounds, glycosides, etc.) metabolites according to their metabolic route of origin, chemical structure and function [34] . Herbal products show a wide spectrum of biological activities and thus are efficiently harnessed for managing diseases [35] .

To meet the challenge of failure in the treatment of gastrointestinal ulcers, an ethnopharmacological survey has been conducted. The populations surveyed are made up of ethnic groups including Fon, Aizo, Mina, Goun, Dendi, Hloua, Houagonou, Ifè and Mahi. This diversity of ethnic groups reflects the ethnic richness of the two research municipalities. This is also reported by Dougnon et al., who found Fon, Aïzo, Mahi, Oueme, Adja, Bariba, Goun, Yoruba, Toffin and Dendi groups [36] . Even if other ethnic groups are represented, it is obvious that the herbalists surveyed during this study are dominated by the Fons. From a religious point of view, we noted the representation of Christianity, Vodoun and Islam. It should be noted that the majority of herbalists surveyed are Christians. This diversity reflects the secular nature of the Republic of Benin, where the religious landscape is made up of three major religions (Vodoun, Christianity and Islam) [37] .

Herbalists in the communes of Abomey-Calavi and Cotonou are categorized into three levels of education: primary, secondary and university, with primary education being the most represented. Our results on the educational level of respondents are similar to those published by Dougnon et al., even though illiterates were not separated out in our case [36] . Furthermore, the seniority of herbalists is represented in four level, with intervals of 1 to 10 years, 10 to 20 years, 20 to 30 years and 30 to 40 years. The 20 to 30 years seniority was the most representative with 32.14%.

The diversity and equitability index of the interviewees calculated revealed that the Dendi, Ifè and Mina, all equitable in their knowledge of anti-ulcer plants, are likely to know more than the other ethnic groups. This steadfast distribution of knowledge of anti-ulcer plants among the Dendi, Ifè and Mina, three different ethnic groups, seems normal and attests to the fusion between these different ethnic groups in view of this knowledge. As reported, differences in language, in the cultural meaning of the plants, in the context related to cultural identities, and in social networks seem to play a fundamental role in the use, diffusion and maintenance or erosion of traditional knowledge about medicinal plants [38] . On the other hand, respondents practicing Islam are likely to know a lot about anti-ulcer plants compared to those practicing Vodou and Christianity, who tend to have the same level of knowledge of anti-ulcer plants. Indeed, a study by Abreu et al. similarly reported this [39] . In addition, these results could be explained by the value and symbolic efficiency accorded or granted by pre-Islamic and Muslim cosmologies to medicinal plants [40] . Traditional societies have their own understandings of medicine as reported by Lightner et al., according to whom lay people and specialists alike made extensive use of abstract concepts that were not obviously supernatural to describe how local medicines work [41] . The influences of religious background on the knowledge and distribution of medicinal plants are recognized and reported. First of all, religion and traditional medicine are so closely linked that some plants are known as religious [42] . So, Albuquerque et al., reported that Religiosity/spirituality (and the dimensions of Commitment and Religious and Spiritual History, in particular) act to protect structural and functional elements of local medical systems (LMSs) and by providing protection, the LMS benefits from greater resilience, at both the individual and population levels. Based on these findings, they suggest that the socialization process resulting from the religious phenomenon has contributed to the complexity and maintenance of local medical systems (LMSs) by means of the interaction of individuals as they engage in their religious observances, thus facilitating cultural transmission [43] . By contrast, religious characteristics such as self-isolation from other cultures might be one of the reasons for such a difference [44] . However, the divergence of said ethnic groups from others in the knowledge of these plants, exhibits an indissolubility of knowledge [39] . The multiple regression analysis carried out reports that neither ethnic group, nor level of education and religion predicts the distribution of knowledge of anti-ulcer plants. Nevertheless, Pérez-Nicolás et al. reported that age and occupation predicted 54% variation in study populations’ knowledge of medicinal plants [45] . This discrepancy between our results could be explained by the fact that our study only considered herbalists.

Plant species from the Benin pharmacopoeia used by herbalists in the communes of Abomey-Calavi and Cotonou for the treatment of gastrointestinal ulcers were reported. A total of 71 species were listed among which the 12 most frequently cited, in decreasing order of frequency, were Vitellaria paradoxa, Parkia biglobosa, Ocimum gratissimum, Khaya senegalensis, Citrus limon, Acacia nilotica ou adansonii, Ocimum canum, Phyllanthus amarus, Senna siamea, Piper guineense, Momordica charantia, Pteleopsis suberosa, Spondias mombin, Sida acuta, Jatropha multifida, Heliotropium indicum, Eugenia aromatica and Crateva adansonii. These species were heterogeneously and co-dominantly cited. Firstly, Vitellaria paradoxa, Parkia biglobosa and Ocimum gratissimum are co-dominant and then Khaya senegalensis, Citrus limon, Acacia nilotica or adansonii, Ocimum canum, Phyllanthus amarus and Senna siamea too. These results are a kind of translation of those obtained by Ouachinou et al. who found 158 medicinal species belonging to 60 families whose population agreed more on the use of Khaya senegalensis, Anacardium occidentale, Cassia sieberiana, Pterocarpus erinaceus and Vitellaria paradoxa to treat gastrointestinal diseases in cattle in Benin [46] . Among the anti-ulcer plants we have identified, Anacardium occidentale; Bambusa vulgaris; Khaya senegalensis; Ocimum gratissimum are reported in an ethnobotanical study by Dougnon, et al. as used against diarrhoea [36] , Vitelaria paradoxa and Parkia biglobosa have been reported for their use against gastrointestinal diseases in Benin [47] . In addition, Xylopia aethiopica, Acanthospermum hispidum, Heliotropium indicum, Combretum micranthum, Pteleopsis suberosa, Acacia nolitica, Parkia biglobosa, Zanthoxylum zanthoxyloides, Vitellaria paradoxa, Bambousa vulgaris, Cymbopogon citratus, Carica papaya were listed as antiulcer plants in an ethnopharmacological study carried out in Burkina Faso [48] . All the species cited are grouped into 44 taxonomic families, of which Fabaceae, Lamiaceae, Sapotaceae, Euphorbiaceae, Rutaceae, Annonaceae, Meliaceae, Malvaceae, Combretaceae and Boraginaceae are the most representative. Meanwhile, Ouachinou et al. reported Leguminosae and Combretaceae to be highly represented in addition of 31 families mentioned as heavily used and the most importants are Zygophyllaceae, Phytolaccaceae, Rubiaceae, Lamiaceae, Loranthaceae, Thymelaeaceae and Flacourtiaceae [46] . On the other hand, Lema et al. recorded 113 species belonging to 48 botanical families, 18 of which are included in the families listed in our study, namely Fabaceae, Lamiaceae, Sapotaceae, Euphorbiaceae, Rutaceae, Annonaceae, Meliaceae, Malvaceae, Combretaceae, Boraginaceae, Poaceae, Myrtaceae, Asteraceae, Anacardiaceae, Bignoniaceae, Apocynaceae, Euphorbiaceae, Caricaceae [48] .

A total of 70 anti-ulcer recipes made from medicinal plants and/or non-wood resources were given by the herbalists surveyed. This number validly represents more than a quarter of the 279 recipes reported by Lema et al. in Burkina Faso and almost 4 times the 18 recipes composed from 16 species reported by Sidio et al. in the Sub-Prefecture of Yopohué in the Centre-West of Côte d’Ivoire for the treatment of gastro-intestinal ulcers [48] [49] .

The results of this survey constitute a database of medicinal plants used to treat gastrointestinal ulcers, which can be used for in-depth studies aimed at identifying molecules active against the disease of interest. Future studies will involve determining the chemical composition of the various species thus identified and characterizing their biological activities. Once identified, evaluated and approved, these molecules can be produced by the method of Plant Pharmaceutical Production using a synthetic biology approach, for which Plants such as alfalfa, barley, corn, duckweed, rice, safflower and tobacco are known and have received Animal and Plant Health Inspection Service (APHIS) regulatory permits for field trials [50] .

5. Conclusion

Benin boasts a wealth of flora, with over 30,700 specimens with therapeutic properties listed. We carried out an ethno-pharmacological survey among herbalists in the communes of Abomey-Calavi and Cotonou to identify the medicinal plant species used to treat gastrointestinal ulcers. We determined 70 anti-ulcer recipes made up of medicinal plant species and/or non-floristic resources and composed of 71 species, of which Vitellaria paradoxa, Parkia biglobosa and Ocimum gratissimum were the first 03 most cited, and the Fabaceae, Lamiaceae and Sapotaceae families were the most strongly represented. A consistent distribution of knowledge of anti-ulcer plants was observed among the Dendi, Ifè and Mina, and respondents practicing Islam were more likely to know many anti-ulcer plants than those practicing Vodou and Christianity. The results of this study provide a good archive for the selection of plant species for further study in the formulation of improved traditional medicines.

Acknowledgements

We gratefully acknowledge Laboratory of Biology and Molecular Typing in Microbiology, Department of Biochemistry and Cell Biology, Faculty of Science and Technology, University of Abomey-Calavi, 05 BP1604 Cotonou, Benin, for providing necessary financial assistance with the AAS analysis.

References

1. Katelaris, P., Hunt, R., Bazzoli, F., Cohen, H., Fock, K.M., Gemilyan, M., et al. (2022) Helicobacter Pylori World Gastroenterology Organization Global Guideline. Journal of Clinical Gastroenterology, 57, 111-126. >https://doi.org/10.1097/mcg.0000000000001719

2. Li, Y., Choi, H., Leung, K., Jiang, F., Graham, D.Y. and Leung, W.K. (2023) Global Prevalence of Helicobacter Pylori Infection between 1980 and 2022: A Systematic Review and Meta-Analysis. The Lancet Gastroenterology&Hepatology, 8, 553-564. >https://doi.org/10.1016/s2468-1253(23)00070-5

3. Selmi, S., Rtibi, K., Grami, D., Sebai, H. and Marzouki, L. (2017) Protective Effects of Orange (Citrus sinensis L.) Peel Aqueous Extract and Hesperidin on Oxidative Stress and Peptic Ulcer Induced by Alcohol in Rat. Lipids in Health and Disease, 16, Article No. 152. >https://doi.org/10.1186/s12944-017-0546-y

4. de Lira Mota, K.S., Dias, G.E.N., Pinto, M.E.F., Luiz-Ferreira, Â., Monteiro Souza-Brito, A.R., Hiruma-Lima, C.A., et al. (2009) Flavonoids with Gastroprotective Activity. Molecules, 14, 979-1012. >https://doi.org/10.3390/molecules14030979

5. Ezzat, R.F., Hussein, H.A., Baban, T.S., Rashid, A.T. and Abdullah, K.M. (2010) Typhoid Ulcer Causing Life-Threatening Bleeding from Dieulafoy’s Lesion of the Ileum in a Seven-Year-Old Child: A Case Report. Journal of Medical Case Reports, 4, Article No. 171. >https://doi.org/10.1186/1752-1947-4-171

6. Sonavane, A.D., Gupta, D., Parmar, T., Sen, S., Nimavat, B., Ambekar, A., et al. (2020) Typhoid Ulcer Related Massive Gastrointestinal Bleeding Successfully Treated with Endoscopic Therapy. The Egyptian Journal of Internal Medicine, 32, Article No. 1. >https://doi.org/10.1186/s43162-020-00004-1

7. Cho, J., Seo, J., Yeom, J.S., Park, J.S., Park, C., Woo, H.O., et al. (2012) Diffuse Colonic Ulcer Caused by Salmonella enteritidisin in a 32-Month-Old Female. Pediatric Gastroenterology, Hepatology&Nutrition, 15, 193-196. >https://doi.org/10.5223/pghn.2012.15.3.193

8. Hung, C. and Wang, P.S. (2004) Gastric Oxidative Stress and Hemorrhagic Ulcer in Salmonella Typhimurium-Infected Rats. European Journal of Pharmacology, 491, 61-68. >https://doi.org/10.1016/j.ejphar.2004.03.029

9. Kawade, D., Shahu, N., Bahadurkar, P., Hiradewe, P. and Dhote, N. (2020) Peptic Ulcer: A Review on Its Etiology, Pathogenesis and Pharmacotherapy. World Journal of Pharmaceutical Research, 9, 558-583.

10. Murray, C.J.L., et al. (2022) Global Burden of Bacterial Antimicrobial Resistance in 2019: A Systematic Analysis. The Lancet, 399, 629-655. >https://doi.org/10.1016/S0140-6736(21)02724-0

11. Fongang, H., Mbaveng, A.T. and Kuete, V. (2023) Global Burden of Bacterial Infections and Drug Resistance. Advances in Botanical Research, 106, 1-20. >https://doi.org/10.1016/bs.abr.2022.08.001

12. Liou, J., Malfertheiner, P., Smith, S.I., El-Omar, E.M. and Wu, M. (2024) 40 Years after the Discovery of Helicobacter Pylori: Towards Elimination of H Pylori for Gastric Cancer Prevention. The Lancet, 403, 2570-2572. >https://doi.org/10.1016/s0140-6736(24)01171-1

13. WHO (2024) WHO Publishes List of Bacteria for Which New Antibiotics Are Urgently Needed. >https://www.who.int/news/item/27-02-2017-who-publishes-list-of-bacteria-for-which-new-antibiotics-are-urgently-needed

14. Dang, B.N. and Graham, D.Y. (2017) Helicobacter Pylori Infection and Antibiotic Resistance: A WHO High Priority? Nature Reviews Gastroenterology&Hepatology, 14, 383-384. >https://doi.org/10.1038/nrgastro.2017.57

15. Jaja, I.F., Bhembe, N.L., Green, E., Oguttu, J. and Muchenje, V. (2019) Molecular Characterisation of Antibiotic-Resistant Salmonella Enterica Isolates Recovered from Meat in South Africa. Acta Tropica, 190, 129-136. >https://doi.org/10.1016/j.actatropica.2018.11.003

16. Onohuean, H. and Igere, B.E. (2022) Occurrence, Antibiotic Susceptibility and Genes Encoding Antibacterial Resistance of Salmonella Spp. and Escherichia coli from Milk and Meat Sold in Markets of Bushenyi District, Uganda. Microbiology Insights, 15, Article 117863612210889. >https://doi.org/10.1177/11786361221088992

17. Cragg, G.M. and Newman, D.J. (2013) Natural Products: A Continuing Source of Novel Drug Leads. Biochimica et Biophysica Acta (BBA)—General Subjects, 1830, 3670-3695. >https://doi.org/10.1016/j.bbagen.2013.02.008

18. Moerman, D.E. (1987) Medicinal Plants of Native America, Vols. 1 and 2. University of Michigan Museum of Anthropological Archaeology. >https://doi.org/10.3998/mpub.11394575

19. Johnson, T. (2019) CRC Ethnobotany Desk Reference. CRC Press. >https://doi.org/10.1201/9781351070942

20. Farnsworth, N., Akerele, O. and Bingel, A. (1987) Medicinal Plants in Therapy. Journal of Ethnopharmacology, 19, 336. >https://doi.org/10.1016/0378-8741(87)90016-x

21. Deng, R., Chen, X., Zhao, S., Zhang, Q. and Shi, Y. (2024) The Effects and Mechanisms of Natural Products on Helicobacter Pylori Eradication. Frontiers in Cellular and Infection Microbiology, 14, Article 1360852. >https://doi.org/10.3389/fcimb.2024.1360852

22. Tesfaye, S., Belete, A., Engidawork, E., Gedif, T. and Asres, K. (2020) Ethnobotanical Study of Medicinal Plants Used by Traditional Healers to Treat Cancer-Like Symptoms in Eleven Districts, Ethiopia. Evidence-Based Complementary and Alternative Medicine, 2020, 1-23. >https://doi.org/10.1155/2020/7683450

23. Kola, P., Metowogo, K., Kantati, Y.T., Lawson-Evi, P., Kpemissi, M., El-Hallouty, S.M., et al. (2020) Ethnopharmacological Survey on Medicinal Plants Used by Traditional Healers in Central and Kara Regions of Togo for Antitumor and Chronic Wound Healing Effects. Evidence-Based Complementary and Alternative Medicine, 2020, 1-12. >https://doi.org/10.1155/2020/6940132

24. Viol, D.I., Chagonda, L.S., Moyo, S.R. and Mericli, A.H. (2016) Toxicity and Antiviral Activities of Some Medicinal Plants Used by Traditional Medical Practitioners in Zimbabwe. American Journal of Plant Sciences, 7, 1538-1544. >https://doi.org/10.4236/ajps.2016.711145

25. Akoègninou, A., Van Der Burg, W.J. and Van Der Maesen, L.J.G. (2006) Flore analytique du Bénin. Wageningen Agricultural University Papers. >http://edepot.wur.nl/281595

26. Adomou, A., Yedomonhan, H., Djossa, B., Legba, S., Oumorou, M. and Akoegninou, A. (2012) Etude Ethnobotanique des plantes médicinales vendues dans le marché d’Abomey-Calavi au Bénin. International Journal of Biological and Chemical Sciences, 6, 745-772. >https://doi.org/10.4314/ijbcs.v6i2.18

27. Dougnon, V., et al. (2024) Utilisation des plantes du Sud-Bénin dans le traitement de la fièvre typhoïde: Rôle des herboristes. Ethnopharmacologia, 11, 64-73. >http://www.ethnopharmacologia.org/prelude2020/pdf/biblio-hd-53-dougnon.pdf

28. Makponse, M. (2019) Commune d’abomey-calavi au bénin, un des milieux de prévalence écologique du Cleome viscosa aux usages socio-économiques multiples. Revue Ivoirienne des Sciences et Technologie, 34, 309-327.

29. INStaD (2004) Cahier des villages et quartiers de ville, Département du LITTORAL. >https://instad.bj/images/docs/insae-statistiques/enquetes-recensements/RGPH/2.RGPH_3/Cahiers-Villages-2002/LITTORAL.pdf

30. INStaD (2004) Cahier des villages et quartiers de ville Département de l’ATLANTIQUE. >https://instad.bj/images/docs/insae-statistiques/enquetes-recensements/RGPH/2.RGPH_3/Cahiers-villages-2002/ATLANTIQUE.pdf

31. Yetein, M.H., Houessou, L.G., Lougbégnon, T.O., Teka, O. and Tente, B. (2013) Ethnobotanical Study of Medicinal Plants Used for the Treatment of Malaria in Plateau of Allada, Benin (West Africa). Journal of Ethnopharmacology, 146, 154-163. >https://doi.org/10.1016/j.jep.2012.12.022

32. Guillaume (2020) Les indices de diversité en écologie des écosystèmes. >https://louernos-nature.fr/indices-de-diversite-ecologie-ecosystemes/

33. Anand, U., Jacobo-Herrera, N., Altemimi, A. and Lakhssassi, N. (2019) A Comprehensive Review on Medicinal Plants as Antimicrobial Therapeutics: Potential Avenues of Biocompatible Drug Discovery. Metabolites, 9, Article 258. >https://doi.org/10.3390/metabo9110258

34. Alamgir, A.N.M. (2018) Therapeutic Use of Medicinal Plants and their Extracts. Springer International Publishing.

35. Shils, M.E., Olson, J.A. and Shike, M. (1995) Modern Nutrition in Health and Disease. 8th Edition, Lea&Febiger. >https://www.cabidigitallibrary.org/doi/full/10.5555/19951402441

36. Dougnon, V., Agbodjento, E., Hounsa, E., Legba, B.B., Deguenon, E., Bohoungbe, N., et al. (2021) An Ethnobotanical Survey of Seventeen Plants Species Used against Diarrhoea and Other Diseases in Southern Benin (West Africa). Journal of Biological Research—Bollettino della Società Italiana di Biologia Sperimentale, 94, 34-42.

37. Ogouby, L.O.A.G. (2008) Les religions dans l’espace public au Bénin : Vodoun, christianisme, islam.>http://digital.casalini.it/9782296203396

38. Menendez-Baceta, G., Aceituno-Mata, L., Reyes-García, V., Tardío, J., Salpeteur, M. and Pardo-de-Santayana, M. (2015) The Importance of Cultural Factors in the Distribution of Medicinal Plant Knowledge: A Case Study in Four Basque Regions. Journal of Ethnopharmacology, 161, 116-127. >https://doi.org/10.1016/j.jep.2014.12.007

39. Abreu, D.B.d.O., Santoro, F.R., Albuquerque, U.P.d., Ladio, A.H. and Medeiros, P.M.D. (2015) Medicinal Plant Knowledge in a Context of Cultural Pluralism: A Case Study in Northeastern Brazil. Journal of Ethnopharmacology, 175, 124-130. >https://doi.org/10.1016/j.jep.2015.09.019

40. Frazão-Moreira, A. (2016) The Symbolic Efficacy of Medicinal Plants: Practices, Knowledge, and Religious Beliefs Amongst the Nalu Healers of Guinea-Bissau. Journal of Ethnobiology and Ethnomedicine, 12, Article No. 24. >https://doi.org/10.1186/s13002-016-0095-x

41. Lightner, A.D., Heckelsmiller, C. and Hagen, E.H. (2021) Ethnomedical Specialists and Their Supernatural Theories of Disease. Review of Philosophy and Psychology, 14, 611-646. >https://doi.org/10.1007/s13164-021-00589-8

42. Sharma, U.K., Pegu, S., Hazarika, D. and Das, A. (2012) Medico-Religious Plants Used by the Hajong Community of Assam, India. Journal of Ethnopharmacology, 143, 787-800. >https://doi.org/10.1016/j.jep.2012.06.053

43. Albuquerque, U.P., Ferreira Júnior, W.S., Sousa, D.C.P., Reinaldo, R.C.P.S., do Nascimento, A.L.B. and Gonçalves, P.H.S. (2018) Religiosity/Spirituality Matters on Plant-Based Local Medical System. Journal of Religion and Health, 57, 1948-1960. >https://doi.org/10.1007/s10943-018-0634-y

44. Simanova, A., Prūse, B., Kalle, R., Kochalski, S., Prakofjewa, J., Mežaka, I., et al. (2020) Medicinal Plant Use at the Beginning of the 21st Century among the Religious Minority in Latgale Region, Latvia. Ethnobotany Research and Applications, 20, 1-31. >https://doi.org/10.32859/era.20.21.1-31

45. Pérez-Nicolás, M., Vibrans, H., Romero-Manzanares, A., Saynes-Vásquez, A., Luna-Cavazos, M., Flores-Cruz, M., et al. (2017) Patterns of Knowledge and Use of Medicinal Plants in Santiago Camotlán, Oaxaca, Mexico. Economic Botany, 71, 209-223. >https://doi.org/10.1007/s12231-017-9384-0

46. Ouachinou, J.M.-.S., Dassou, G.H., Idohou, R., Adomou, A.C. and Yédomonhan, H. (2019) National Inventory and Usage of Plant-Based Medicine to Treat Gastrointestinal Disorders with Cattle in Benin (West Africa). South African Journal of Botany, 122, 432-446. >https://doi.org/10.1016/j.sajb.2019.03.037

47. Odounharo, O.G.R., Gnansounou, S.C., Salako, K.V., Idohou, R., Mensah, G.A., Glèlè Kakaï, R., et al. (2021) Medicinal Use Patterns of Parkia biglobosa (jacq.) Benth. and Vitellaria paradoxa (Gaertn. F), Two Important Traditional Agroforestry Species in Benin, West-Africa. Advances in Traditional Medicine, 22, 531-545. >https://doi.org/10.1007/s13596-021-00583-6

48. Armandine, L.E.M.A., Mindiédiba Jean, B.A.N.G.O.U., et al. (2022) Medicinal Plant Recipes Used in the Management of Peptic Ulcers in Burkina Faso: Ethnobotanical Study. International Journal of Science and Research Archive, 6, 263-278. >https://doi.org/10.30574/ijsra.2022.6.1.0133

49. Sidio, S.R., Wangny, A.A.S., Angaman, K.R. and N’guessan, K. (2021) Ethnomedical Inventory of Antiulcer Plants Used by the tradipraticians of Yopohué sub-prefecture in central-western Côte d’Ivoire. Journal of Medicinal Plants Studies, 9, 129-135. >https://www.plantsjournal.com/archives/?year=2021&vol=9&issue=3&part=B&ArticleId=1279

50. Sil, B. and Jha, S. (2014) Plants: The Future Pharmaceutical Factory. American Journal of Plant Sciences, 5, 319-327.