Prostaglandins and clinical experience in peptic ulcer disease

Synthetic prostaglandin analogues of the E series offer a new approach to the medical treatment of peptic ulcer disease by combining antisecretory with cytoprotective properties, such as protection of the gastric mucosa against damage induced by aspirin. Controlled trials of prostaglandin analogues in peptic ulcer healing have failed to demonstrate any superiority to conventional treatment. Any beneficial effect is explicable by acid inhibition, and diarrhoea is a major and dose-limiting side effect. Non-antisecretory doses that are still said to be cytoprotective do not accelerate ulcer healing. Also, the prostaglandin analogues seem ineffective in the treatment of peptic ulcer haemorrhage. Thus the clinical relevance of cytoprotection by synthetic prostaglandins has not been established. Although antisecretory doses of some analogues may prove to be yet another approach to drug treatment, the present results do not forecast a new breakthrough in the management of peptic ulcer disease.