Preclinical evidence of the therapeutic effect of Moringa oleifera in peptic ulcer disease: a systematic review and meta-analysis

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 standard mean difference (SMD). Heterogeneity was assessed with I 2 , 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; I 2 = 69%), while comparisons with basal controls also lacked significance (SMD = 0.99; 95% CI: 0.24–2.22; p = 0.11). Sensitivity analyses resolved heterogeneity (I 2 = 0%) and publication bias, without altering overall outcomes. Conclusion Moringa oleifera demonstrates consistent gastroprotective and ulcer-healing effects in preclinical studies, though not 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. Systematic Review Registration Identifier CRD420251080346.