Protective effects of prostaglandins against gastric mucosal damage: current knowledge and proposed mechanisms

Recent evidence indicates that prostaglandins (PGs) possess potent gastric antiulcer properties independent of their known inhibitory effects on acid secretion. The mechanism underlying this cytoprotective property, as it has been called, has remained elusive. Although exogenously administered PGs can prevent disruption of the gastric mucosal barrier, enhance gastric mucosal blood flow, and stimulate mucus and bicarbonate secretion, as well as a number of cellular transport processes, evidence for and against each of these proposed mechanisms for cytoprotection has been demonstrated. Thus, it is doubtful whether any of these effects of PGs on gastric epithelium is the mechanism responsible for cytoprotection, if indeed a single, common mechanism exists. In addition, an association between alterations in endogenous PGs and gastric mucosal injury induced by a variety of damaging agents has also been observed, but the importance of this association in terms of mediating gastric damage needs further clarification. Finally, the phenomenon of adaptive cytoprotection in which mild irritants protect the gastric mucosa against the damaging effects of various necrotizing agents may also be PG mediated since it can be blocked by indomethacin, an inhibitor of PG synthesis, but a clear association between changes in endogenous PGs and adaptive cytoprotection remains to be demonstrated. Despite being inconclusive, these findings suggest that PGs may play a significant role in the pathogenesis of gastric ulceration and may serve an important function in maintaining normal gastric mucosal integrity.