Mucosal protection by H2 antagonists against injury by non-steroidal anti-inflammatory agents

It is difficult to ascertain the incidence of gastrointestinal side effects associated with intake of non-steroidal anti-inflammatory drugs (NSAIDs). Serious side effects, such as bleeding, perforation, and heart failure, occur in approximately 1% of patients using NSAIDs. One-third of all patients receiving NSAIDs will have gastrointestinal complaints. Since at least 10% of patients terminate treatment with NSAIDs as a result of side effects, even reduction of those that are not life-threatening would be of great benefit. H2-receptor antagonists have proved effective in ulcer treatment, and their use as prophylaxis against the side effects of NSAIDs is being widely studied. In a recent study, 63 patients who had experienced serious upper gastrointestinal side effects were given cimetidine while continuing their NSAID therapy. All but 4 of 47 who had gastric or duodenal ulcer on first admission were healed at 8 weeks, and none of the remaining 16 with diffuse bleeding gastritis experienced further clinical episodes of bleeding or ulcer-related dyspepsia. Bijlsma has reported a double-blind multicentre study using cimetidine or placebo. When GI symptoms led to endoscopic evaluation, GI symptoms were significantly reduced after cimetidine.