Misoprostol in patients taking non-steroidal anti-inflammatory drugs

The past decade has seen considerable improvements in attempts to prevent the gastrointestinal complications of non-steroidal anti-inflammatory drugs. Increased awareness of the problems that these compounds cause and more careful prescribing have had an appreciable effect, although better access to diagnostic facilities and the availability of drugs both to treat and to prevent gastroduodenal ulceration have also contributed. However, progress in preventing the relatively rare but potentially life threatening complications such as perforation and gastrointestinal haemorrhage has until recently been disappointing. The availability of misoprostol, a synthetic analogue of prostaglandin, has provided some cause for optimism. Endoscopic studies show that misoprostol reduces the frequency of asymptomatic gastric and duodenal ulceration induced by non-steroidal anti-inflammatory drugs, while ranitidine reduces only the frequency of duodenal ulcers but is better tolerated.1 2 The extent of benefit from proton pump inhibitors such as omeprazole is being evaluated. A more pressing and important question is whether prophylactic use of such drugs can reduce the frequency of the …