© 1993 British Society for Rheumatology
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THE PREVENTION AND HEALING OF ACUTE NON-STEROIDAL ANTI-INFLAMMATORY DRUG-ASSOCIATED GASTRODUODENAL MUCOSAL DAMAGE BY MISOPROSTOL
*District General Hospital Rotherham S60 2UD;
King's College Hospital London SE59RS
St Bartholomew's Hospital London ECIM 6BQ
Medical and Clinical Research Department Searle, High Wycombe, HP124HL
This double-blind study assessed the acute development of NSAID-associated gastroduodenal (GD) damage and its prevention by misoprostol. Patients requiring chronic NSAID therapy were stratified into two groups depending on initial endoscopic appearance, Group 1: normal (n = 223); Group 11: non-ulcer lesions (n = 78). After 2 weeks of therapy with NSAID and either misoprostol 400–800 µg daily or placebo the incidence of severe mucosal damage (including ulcers) was significantly reduced by misoprostol (odds ratio; 95% CI). Group 1: 4.52; 1.94, 10.51 (P = 0.018); Group II: 10.93; 1.09, 109.60 (P = 0.014); Groups I and II combined: 5.95; 3.23, 10.94 (P = 0.0003). Misoprostol exerted a significant protective effect against progression of minor to severe damage in Group II (P<0.001). Endoscopic findings did not correlate significantly with gastrointestinal symptoms and misoprostol did not interfere with the NSAID efficacy. Significant GD damage occurs early in the course of NSAID treatment and misoprostol significantly reduces the incidence of such damage.
KEY WORDS: Gastroduodenal damage, Non-steroidal anti-inflammatory drugs
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