Misoprostol is significantly more effective than sucralfate in preventing gastric ulcer, according to a study by Tulane Medical School, New Orleans. After 3 months of treatment, 1 .6% of patients (2 of 122) taking misoprostol and nonsteroid anti-inflammatory drugs (NSAIDs) concurrently were found to have a gastric ulcer, compared with 16% of patients (21 of 131) taking sucralfate with NSAIDs. Gastric ulcers have been shown to occur in 10% to 25% of the population taking NSAIDs chronically.
Because sucralfate causes endogenous prostaglandins to be released into the gastric mucosa, it was hypothesized that it might be as protective as misoprostol, which is a synthetic prostaglandin E1 analog. Prostaglandins not only enhance defensive factors in the gastric mucosa, but they also inhibit gastric acid secretion.
The current findings parallel those of an earlier investigation that examined the short-term effects (after 7 days) of misoprosiol and sucralfate in conjunction with acute NSAID use. In that study, misoprostol protected subjects against NSAID-induced gastric lesions (erosions or hemorrhages); sucralfate and placebo did not.
In this study, 356 patients with osteoarthritis who did not have a gastric ulcer at initial endoscopy participated: 253 were evaluated after the 3-month treatment period. Patients were randomly assigned to receive misoprosiol, 200 µg four times daily, or sucralfate, 1 gm four times daily (30 minutes before meals), in addition to their NSAID. The most common adverse effect of either treatment was dyspepsia.
Misoprostol is indicated for the prevention of NSAID-induced gastric ulcers in patients at high risk for such ulcers and their complications. Misoprostol is contraindicated for pregnant women.
For more information, contact Fran Simon, Tulane University Medical Center, Office of Public Relations and Information, 1430 Tulane Avenue, New Orleans, LA 701 1 2-2699; 504-588-5221.