A Review of Mucosal Protection by Synthetic Prostaglandin E Analogs Against Injury by Nonsteroidal Anti-Inflammatory Agents

Non-steroidal anti-inflammatory agents (NSAIDs) damage the gastric mucosa both in normal volunteers and in arthritic patients. Four large studies have been done in our laboratory comparing the prostaglandin E analog misoprostol against placebo, cimetidine, and sucralfate. These studies showed that misoprostol protected the stomach significantly better than cimetidine or sucralfate. In the duodenum, misoprostol and cimetidine were equally effective. Comparison of secretory and anti-secretory doses of misoprostol reveal duodenal protection with the former but not with the latter, but gastric protection with both doses, suggesting that cytoprotective mechanisms other than acid suppression exist in the stomach in subjects taking prostaglandins. Adequately controlled and blind studies reported in the literature in arthritic patients are also reviewed, and it would appear that prostaglandins offer the best currently available method of providing mucosal protection for patients taking NSAIDs.