EFFECT OF LONG-TERM MISOPROSTOL COADMINISTRATION WITH NONSTEROIDAL ANTIINFLAMMATORY DRUGS - A HISTOLOGICAL STUDY

Prostaglandins are widely used in the prevention and healing of non-st eroidal antiinflammatory drug (NSAID) induced gastric and duodenal ulc ers, but their longterm effect on the human gastric mucosa is unknown. This study assessed the effect of coadministration of prostaglandins with NSAIDs on the histology of the gastroduodenal mucosa. Histologica l appearances (using the Sydney system) of gastric biopsy specimens fr om 180 patients receiving longterm NSAID treatment of whom 90 had been receiving misoprostol (400-800 mu g/day) for one to two years were st udied. Both groups of patients were comparable with regard to clinical and demographic details. There was no significant difference (p > 0.1 ) in the prevalence of chronic gastritis (total, corpus or antrum only ) between patients receiving (36 of 90 (40%)) or not receiving misopro stol (35 of 90 (39%)). Chronic gastritis was equally associated with t he presence of Helicobacter pylori, 86% and 73% (p > 0.1), respectivel y, in the two groups. Significantly fewer patients receiving misoprost ol had reactive gastritis than those receiving only NSAIDs (8 (9%) ver sus 27 (30%), p < 0.01). Reactive gastritis was not associated with H pylori. Thirty nine (43%) of the misoprostol treated patients had norm al histology compared with 16 (18%) receiving only NSAIDs (p < 0.01). These results show two different patterns of gastric damage in patient s receiving NSAIDs, namely chronic and reactive gastritis. Misoprostol treatment was associated with a significantly reduced prevalence of r eactive gastritis and it is suggested that this, along with its antise cretory action, may explain the reduced prevalence of gastroduodenal l esions when coadministered with NSAIDs.