Cytoprotection with misoprostol: use in the treatment and prevention of ulcers

Prostaglandins protect the gastric mucosa by decreasing gastric acid secretion, increasing mucus and bicarbonate production and maintaining mucosal blood flow. Non-steroidal anti-inflammatory drugs (NSAIDs) cause gastroduodenal damage and this is due, at least in part, to inhibition of mucosal prostaglandin production. Misoprostol is a synthetic analogue of prostaglandin E1 which has been used in the healing of ulcers and prevention of peptic ulcers in patients taking NSAIDs. Misoprostol is of equal efficacy to H2 antagonists in the healing of ordinary peptic ulcers (not associated with NSAIDs). Misoprostol is superior to placebo in healing NSAID ulcers during continued NSAID treatment but there have been no comparative trials with other ulcer-healing drugs. Misoprostol, H2 antagonists and sucralfate are of similar efficacy in prevention of NSAID-associated duodenal ulcers but misoprostol is more effective in prevention of gastric ulcers. Misoprostol has not been compared to omeprazole in this situation.