Use of antisecretory drugs for gastroprotection during antiblastic chemotherapy

Both prednisone and cytostatic drugs have an ulcerogenic effect on digestive mucosa. The protective action of the antisecretory drugs pirenzepine and ranitidine are compared against gastroduodenal lesions induced by antiblastic therapy. Twenty patients affected with lymphoproliferative disorders were endoscopically examined: none of them suffered from gastric or duodenal peptic ulcers or erosions. Ten out of the 20 patients received pirenzepine 100 mg/die/p.o. and the other 10 received ranitidine 300 mg/die/p.o. The study was performed according to a double-blind, randomized sequence. The antisecretory medication was administered together with antitumoral therapy for periods of 3-6 months. Four patients died of haematological complications before the course of treatment was completed. A further endoscopic examination was performed at the end of treatment: no patient showed evidence of gastric or duodenal peptic ulcers or erosions. Among the pirenzepine-treated cases, 1 out of the 7 evaluable patients showed a histological worsening of a pre-existing gastritis, while a slight duodenitis was observed in 1 out of the 9 ranitidine-treated patients. The comparable effectiveness of the two drugs is probably related to their antisecretory action, but cytoprotective mechanisms cannot be excluded.