PREVENTION AND TREATMENT OF ULCERS INDUCED BY NONSTEROIDAL ANTIINFLAMMATORY DRUGS - AN UPDATE

Nonsteroidal anti-inflammatory drugs (NSAIDs) are most frequently used for the treatment of rheumatic disease due to their anti-inflammatory and analgesic properties. All NSAIDs have the potential to cause dama ge to the gastrointestinal (GI) tract and have been associated with th e induction of peptic ulcers and massive life-threatening bleeding. Th e therapeutic approaches for the treatment and prevention of NSAID-ind uced ulcers is critically reviewed using data derived from carefully c ontrolled, world-wide clinical studies with anti-ulcer drugs. Histamin e (H-2) antagonists, omeprazole, sucralfate and E-prostaglandin (PGE) analogs are effective for the treatment of NSAID-induced gastric and d uodenal ulcers, if NSAIDs are discontinued. However, if NSAIDs are con tinued while GI damage is present, the PGE analogs misoprostol, arbapr ostil and enprostil have shown efficacy in healing NSAID-induced ulcer s. Furthermore, one limited clinical study demonstrated that omeprazol e has efficacy in healing NSAID-associated ulcers. Neither H-2 antagon ists, sucralfate and sulglycotide (a cytoprotective drug) have shown e fficacy in preventing NSAID-induced gastric ulcers, However H-2 antago nists have shown efficacy in preventing NSAID-induced duodenal ulcers. In contrast, only misoprostol prevents the development of NSAID-induc ed gastric and duodenal ulcers, Such pharmacological observations sugg est that the pathophysiologic mechanisms for the induction of NSAID-in duced gastric ulcer are distinctly different from those of NSAID-induc ed duodenal ulcers. Mild diarrhea and GI intolerance were the predomin ant adverse reactions experienced by patients receiving synthetic PGEs , particularly enprostil and arbaprostil. From the published data, we conclude that misoprostol is the only anti-ulcer drug proven to be wel l tolerated and effective for the treatment and prevention of NSAID-in duced gastric and duodenal ulcers in patients receiving chronic NSAIDs therapy.