ROLE OF ACID AND SALIVARY EPIDERMAL GROWTH-FACTOR IN GASTRIC-MUCOSAL ADAPTATION TO NAPROXEN IN MAN

Background: Non-steroidal anti-inflammatory drugs (NSAIDs) frequently damage the gastrointestinal tract, but with continued administration t his usually resolves by a process of adaptation. There is evidence tha t the acute injury can be reduced by acid suppression, and animal mode ls have shown that salivary epidermal growth factor (EGF) is an import ant factor in gastric mucosal adaptation. We therefore wanted to asses s the effect of acid suppression and salivary EGF output during naprox en-induced acute gastric injury and subsequent adaptation. Methods: He althy subjects were given a 14-day course of naproxen with different r egimens of ranitidine and placebo. Before and on three occasions durin g treatment subjects provided a salivary sample for EGF and underwent gastroscopy to assess gastric damage. Results: Similar gastric damage occurred after 24 h in all groups and resolved in most subjects. Base- line salivary EGF output was similar in all groups but increased in th e placebo/ranitidine group on day 3 and in the ranitidine group on day 9. Conclusions: Acid suppression with ranitidine did not prevent acut e gastric injury. Adaptation may be associated with an increase in sal ivary EGF output.