Misoprostol Compared with Sucralfate in the Prevention of Nonsteroidal Anti-inflammatory Drug-induced Gastric Ulcer

Abstract

In patients receiving chronic NSAID therapy for osteoarthritis, treatment with misoprostol for 3 months was associated with a significantly lower frequency of gastric ulcer formation, compared with treatment with sucralfate (P less than 0.001).

The Use of Nonsteroidal Anti-Inflammatory Drugs and the Occurrence of Gastric Lesions Among Patients Undergoing Upper Endoscopy in a University Hospital in Brazil

“…Although some authors do not consider the erosions to be precursors to gastrointestinal complications since they hardly ever develop into ulcers, 21,22 other studies show a higher risk of gastric ulcers in patients whose diagnosis confirmed gastric erosions and a chronicle use of NSAIDs, independent of the prophylactic treatment. 23,24 These findings were confirmed by another study that also suggested that the presence of erosions is a better predictor of ulceration risk than the number of gastric erosions. 25 In spite of the methodological differences between the present study and the other ones cited, the prevalence of 81.0% of gastric erosions in long-term NSAID users suggests the necessity for strict attention, so that gastrointestinal complications such as digestive hemorrhage or gastric ulcer can be prevented.…”

A guideline for the treatment and prevention of nsaid-induced ulcers

“…Numerous RCTs have been carried out, both in normal volunteers and in patients with arthritic disorders, to evaluate the efficacy of coadministration of various agents for the prevention of both NSAID-related, nonulcer gastropathy and GU and DU (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28). Generally, these have shown that concomitant administration of the prostaglandin E1 analog misoprostol along with various NSAIDs can prevent both GU and DU (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23); that the proton pump inhibitor (PPI) (24 -26) omeprazole reduces GU and prevents DU; and that H2 receptor antagonists are effective in preventing DU but not GU (27,28).…”

“…Generally, these have shown that concomitant administration of the prostaglandin E1 analog misoprostol along with various NSAIDs can prevent both GU and DU (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23); that the proton pump inhibitor (PPI) (24 -26) omeprazole reduces GU and prevents DU; and that H2 receptor antagonists are effective in preventing DU but not GU (27,28).…”

“…Sucralfate has not been shown to be effective in preventing NSAID-related ulcers (13,18,71). In a recent study from two sites in Europe, 107 arthritic patients were randomly allocated to receive diclofenac 200 mg/day or naproxen 1 g/day, plus sucralfate gel 1 g b.i.d.…”

Nonsteroidal Anti-Inflammatory Drugs: Gastroduodenal Injury and Beyond

“…Sucralfate may possi bly prevent NSAID-induced duodenal ulcers, but it has no efficacy in preventing gastric ulcers [67] and it cannot be recommended as a prophylactic agent [42],…”