Prevention of posttransplant peptic ulcer by misoprostol

Misoprostol is effective in protecting the gastric mucosa against various injuries (cytoprotection), but its role in preventing peptic ulcer disease (PUD) is controversial. Therefore, this study was designed to evaluate the effect of misoprostol on preventing posttransplant PUD. 87 patients undergoing kidney transplantation (KT) were randomly separated into three groups according to the antiulcer regimen. Group 1 (n = 28) received antacid and ranitidine; group 2 (n = 34) received antacid, ranitidine, and bismuth (De Nol), and group 3 (n = 25) received antacid, ranitidine, and misprostol (prostaglandin E1). Antiulcer drugs started 1 week before KT and were continued after surgery. A pretransplant gastrofibroscopy was performed 1 month before KT, and a follow-up gastroscopy was performed 2-3 weeks after KT. The incidence of peptic ulcer in groups 1 and 2 was 50.0% (14/28) and 35.3% (12/34), respectively (p > 0.05 groups 1 vs. 2). In group 3, 12.0% (3/25) of the patients showed PUD (p < 0.05 when compared with group 1 or 2). The known risk factors of posttransplant PUD were not significantly different in three groups, but the KT recipients of groups 1 and 2 had 7.8 times the risk of PUD when compared with group 3. In conclusion, the antiulcer regimen including misoprostol is more effective than ranitidine or bismuth in preventing posttransplant PUD, and the antiulcer effect of misoprostol seems to be related to the cytoprotective effect of the drug.