Misoprostol compared with sucralfate in the prevention of nonsteroidal anti-inflammatory drug-induced gastric ulcer: a randomized, controlled trial

Article Abstract:

Pain relievers in the category nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used to treat arthritic conditions, but they are not without side effects. One of the more serious adverse effects associated with NSAIDs is an increased risk of ulcer disease with serious bleeding complications. NSAIDs block the production of important substances known as prostaglandins, some of which act to protect the wall of the stomach from damage. Misoprostol is a synthetic prostaglandin that has been shown to decrease adverse effects on the stomach wall when given to patients also taking NSAIDs. The anti-ulcer drug sucralfate has also been used to prevent ulcers in those patients who must take NSAIDs. However, no study has compared the two drug to determine which is most effective. A group of nearly 300 patients who were taking NSAIDs were assigned to also take either misoprostol or sucralfate, and were then followed to see if they developed ulcer disease despite the preventive therapy. Of the 253 patients who completed the study, 2 of the 122 patients taking misoprostol developed ulcers, and 21 of the 131 patients taking sucralfate developed stomach ulcers. Erosions in the stomach wall are thought to be precursors of ulcers. The frequency of the erosions in the misoprostol group declined over the course of the study, while those in the sucralfate group were unchanged. The side effect profile of the two drugs differed. Eighteen percent of the misoprostol patients stopped the medication because of side effects (chiefly diarrhea) compared with 9 percent of the sucralfate patients. Thus, misoprostol was clearly superior to sucralfate in the prevention of stomach ulcers in patients who also take NSAIDs, but does produce side effects in significantly more patients. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Peptic ulcer, Sucralfate

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Misoprostol dosage in the prevention of nonsteroidal anti-inflammatory drug-induced gastric and duodenal ulcers: a comparison of three regimens

Article Abstract:

Two to three 200 microgram (mcg) daily doses of misoprostol seem to give the best protection against stomach and intestinal ulcers in patients with arthritis taking nonsteroidal anti-inflammatory drugs (NSAIDS). Researchers studied the protective effects of varying daily doses of misoprostol on 1197 patients with arthritis taking NSAIDS. Participants took either placebo four times daily, misoprostol twice daily and placebo twice daily, misoprostol three times daily and placebo once daily, or misoprostol four times daily. The incidence of stomach ulcers was 15.7% for the placebo group, 8.1% for the twice daily group, 3.9% for the three times daily group, and 4.0% for the four times daily group. The incidence of intestinal ulcers was 7.5% for the placebo group, 2.6% for the twice daily group, 3.3% for the three times daily group, and 1.4% for the four times daily group.

Care and treatment, Arthritics, Stomach ulcer, Duodenal ulcer

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Duodenal and gastric ulcer prevention with misoprostol in arthritis patients taking NSAIDS

Article Abstract:

Misoprostol may decrease the risk of developing an ulcer in patients receiving long-term treatment with nonsteroidal anti-inflammatory drugs (NSAID). Patients treated with NSAIDs have a higher risk of developing peptic ulcers. Among 643 arthritis patients being treated with an NSAID who did not have an ulcer, 320 were treated with 400 micrograms of misoprostol and 323 were treated with a placebo, an inactive substance, four times a day for 12 weeks. Two percent of the patients treated with misoprostol developed a stomach ulcer, compared with 8% of those who received a placebo. One percent of the patients in the misoprostol group developed an duodenal ulcer, compared with 5% of those in the placebo group. The duodenum is a segment of the small intestine.

Ulcers

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