Skip to main content
Log in

Treatment of nonsteroidal antiinflammatory drug-induced gastric ulcers with misoprostol

A double-blind multicenter study

  • Original Articles
  • Published:
Digestive Diseases and Sciences Aims and scope Submit manuscript

Abstract

One hundred sixty-two patients chronically ingesting ibuprofen, piroxicam, or naproxen for osteoarthritis, who had abdominal pain and an endoscopically proven gastric ulcer were evaluated for eight weeks in a randomized, double-blind trial comparing misoprostol (200 μg four times daily with meals and at bedtime) (N=77) with placeboN=85). Patients discontinued their usual daily dose of antiarthritic medication throughout the study period, and an endoscopy was performed at four weeks and eight weeks (if necessary) to assess ulcer healing. Gastric ulcers were defined as circumscribed breaks in the gastric mucosa of 0.3 cm in diameter or greater. Misoprostol therapy significantly accelerated the rate of gastric ulcer healing compared to placebo (P=0.033). The cumulative percent healed after four and eight weeks of therapy for misoprostol versus placebo were: 83% vs 61% at four weeks and 96% vs 90% at eight week (P=0.0028 andP=0.0977, respectively by lifetable analysis). Relief of abdominal pain did not differ significantly between the treatment groups. Misoprostol significantly accelerates the healing of ibuprofen-piroxicam-, or naproxen-induced gastric ulcers.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Pemberton RE, Strand LJ: A review of upper gastrointestinal effects of newer nonsteroid antiinflammatory drugs. Dig Dis Sci 24:53–62, 1979

    Google Scholar 

  2. Castles JJ, Moore TL, Vaughan JG, Bolzan JA, Lee M, Lidsky MD, Caldwell JR, Ehrllich GE, Sharp JT, Kaye R: Multicenter comparison of naproxen and indomethacin in rheumatoid arthritis. Arch Intern Med 138:362–366, 1978

    Google Scholar 

  3. Lanza FL, Royer GL, Nelson RS, Chen TT, Seckman CE, Rack MF: A comparative endoscopic evaluation of the damaging effects of nonsteroidal anti-inflammatory agents on the gastric and duodenal mucosa. Am J Gastroenterol 75:17–21, 1981

    Google Scholar 

  4. Lanza FL, Royer GL Jr, Nelson RS, Chen TT, Seckman CE, Rack MF: The effects of ibuprofen, indomethacin, aspirin, naproxen, and placebo on the gastric mucosa of normal volunteers. A gastroscopic and photographic study. Dig Dis Sci 24:823–828, 1979

    Google Scholar 

  5. Bunnett NW Walsh JH, Debas HT, Kauffman GL, Golanska EM: Measurement of prostaglandin E2 in interstitial fluid from the dog stomach after feeding and indomethacin. Gastroenterology 85:1391–1398, 1983

    Google Scholar 

  6. Konturek SJ, Piastucki I, Brzozowski T, Radecki T, Dembinska-Kiec A, Zmuda A, Gryglewski R: Role of prostaglandins in the formation of aspirin-induced gastric ulcers. Gastroenterology 80:4–9, 1981

    Google Scholar 

  7. Rainsford KD, Willis C: Relationship of gastric mucosal damage induced in pigs by antiinflammatory drugs to their effects on prostaglandin, synthesis. Dig Dis Sci 27:624–635, 1982

    Google Scholar 

  8. Caruso I, Bianchi Porro G: Gastroscopic evaluation of anti-inflammatory agents. Br Med J 28075–78, 1980

    Google Scholar 

  9. Silvoso GR, Ivey KJ, Butt JH, Lockard OO, Holt SD, Sisk C, Baskin WN, Mackercher PA, Hewett J: Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy. Ann Intern Med 91:517–520, 1979

    Google Scholar 

  10. Armstrong CP, Blower AL: Non-steroidal anti-inflammatory drugs and life threatening complications of peptic ulceration. Gut 28:527–532, 1987

    Google Scholar 

  11. Griffin MR, Ray WA, Schaffner W Nonsteroidal antiinflammatory drug use and death from peptic ulcer in elderly persons. Ann Intern Med 109:359–363, 1988

    Google Scholar 

  12. Griffin MR, Piper JM, Daugherty JR, Snowden M, Ray WA: Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer diseases in, elderly persons. Ann Intern Med 114:257–263, 1991

    Google Scholar 

  13. Loludice TA, Saleem T, Lang JA: Cimetidine in the treatment of gastric ulcer induced by steroidal and nonsteroidal anti-inflammatory agents. Am J Gastroenterol 75:104–110, 1981

    Google Scholar 

  14. Maniche C, Malchow-Moller A, Anderson JR, Pedersen C, Hansen TM, Jess P, Helleberg L, Rasmussen SN, Tage-Jensen U, Nielsen SE: Randomized study of the influence of non-steroidal anti-inflammatory drugs on the treatment of peptic ulcer in patients with rheumatic disease. Gut 28:226–229, 1987

    Google Scholar 

  15. Bianchi Porro G, Parente F: Recent developments in peptic ulcer treatment. Scand J Gastroenterol 23(suppl 146): 159–165, 1988

    Google Scholar 

  16. O'Laughlin JC, Silvoso GK, Ivey JK: Resistance to medical therapy of gastric ulcers in rheumatic disease patients, taking asprin. A double-blind study with cimetidine and follow-up. Dig Dis Sci 27:976–980, 1982

    Google Scholar 

  17. Davies J, Collins AJ, Dixon A St J: The influence of cimetidine on peptic ulcer in patients with arthritis taking anti-inflammatory drugs. Br J Rheumatol 25:54–58, 1986

    Google Scholar 

  18. Agrawal NM, Saffouri B, Kruss DM, Tapper EJ: Healing of benign gastric ulcer: A placebo controlled comparison of two dosage regimens of misoprostol, a synthetic analog of prostaglandin E. Dig Dis Sci 30(suppl):164S-170S, 1985

    Google Scholar 

  19. Brand DL, Roufail WM, Thomson ABR, Tapper EJ: Misoprostol, a synthetic prostaglandin E1 analog in the treatment of duodenal ulcers: A multicenter double-blind study. Dig Dis Sci 30:147S-158S, 1985

    Google Scholar 

  20. Graham DY, Agrawal NM, Roth SH: Prevention of NSAID-Induced gastric ulcer with misoprostol: Multicentre, double-blind, placebo-controlled trial. Lancet 2:1277–1280, 1988

    Google Scholar 

  21. Jaszewski R: Frequency of gastroduodenal lesions in asymptomatic patients on chronic aspirin or nonsteroidal antiinflammatory drug therapy. J Clin Gastroenterol 12(1):10–13, 1990

    Google Scholar 

  22. Hunt JN, Franz DR: Effect of prostaglandin E2 on gastric mucosal bleeding caused by aspirin. Dig Dis Sci 26:301–305, 1981

    Google Scholar 

  23. Gilbert DA, Surawicz CM, Silverstein FE, Weinberg ER, Saunders DR, Feld AD, Sanford FR, Bergman D, and Washington P: Prevention of acute aspirin-induced gastric mucosal injury by 15-R-15-methyl prostaglandin E2: An endoscopic study. Gastroenterology 86:339–345, 1984

    Google Scholar 

  24. Hunt JN, Smith JL, Jiang CL, Kessler L: Effect of synthetic protaglandin E1 analog on aspirin-induced gastric bleeding and secretion. Dig Dis Sci 28:897–902, 1983

    Google Scholar 

  25. Cohen MM, Clark L, Armstrong L, D'Souza J: Reduction of aspirin-induced fecal blood loss with low-dose misoprostol tablets in man. Dig Dis Sci 30:605–611, 1985

    Google Scholar 

  26. Johansson C, Kollberg B: Stimulation by intragastrically administered E2 prostaglandins of human gastric mucus output. Eur J Clin Invest 9:229–232, 1979

    Google Scholar 

  27. Feldman M: Gastric bicarbonate secretion in humans. Effect of pentagastrin, bethanecol, and 11, 16, 16-trimethyl prostaglandin E2. J Clin Invest 72:295–303, 1983

    Google Scholar 

  28. Dajani EZ: Perspective on the gastric antisecretory effects of misoprostol in man. Prostaglandin 33(suppl):68–77, 1987

    Google Scholar 

  29. Roth S, Agrawal N, Mahowald M, Montoya H, Robbins D, Miller S, Nutting E, Woods E, Crager M, Nissen C, Swabb E: Misoprostol heals gastroduodenal injury in patients with rheumatoid arthritis receiving aspirin. Arch Intern Med 149(4):775–779, 1989

    Google Scholar 

  30. Jaszewski R, Calzada R, Dhar R: Persistence of gastric ulcers caused by plain aspirin or nonsteroidal antiinflammatory agents in patients treated with a combination of cimetidine, antacids, and enteric-coated aspirin. Dig Dis Sci 34:1361–1364, 1989

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jaszewski, R., Graham, D.Y. & Stromatt, S.C. Treatment of nonsteroidal antiinflammatory drug-induced gastric ulcers with misoprostol. Digest Dis Sci 37, 1820–1824 (1992). https://doi.org/10.1007/BF01308074

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01308074

Key Words

Navigation