This study provides evidence that non-steroidal anti-inflammatory toxicity persists with continuous exposure. There seems to be carryover toxicity after the end of prescribing. These findings have implications for the management of patients requiring non-steroidal anti-inflammatory drugs.

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This double-blind study assessed the acute development of NSAID-associated gastroduodenal (GD) damage and its prevention by misoprostol. Patients requiring chronic NSAID therapy were stratified into two groups depending on initial endoscopic appearance, Group I: normal (n = 223); Group II: non-ulcer lesions (n = 78). After 2 weeks of therapy with NSAID and either misoprostol 400-800 micrograms daily or placebo the incidence of severe mucosal damage (including ulcers) was significantly reduced by misoprostol (odds ratio; 95% CI). Group I: 4.52; 1.94, 10.51 (P = 0.018); Group II: 10.93; 1.09, 109.60 (P = 0.014); Groups I and II combined: 5.95; 3.23, 10.94 (P = 0.0003). Misoprostol exerted a significant protective effect against progression of minor to severe damage in Group II (P < 0.001). Endoscopic findings did not correlate significantly with gastrointestinal symptoms and misoprostol did not interfere with the NSAID efficacy. Significant GD damage occurs early in the course of NSAID treatment and misoprostol significantly reduces the incidence of such damage.

Introduction: The harmful effects of non‐steroidal anti‐inflammatory drugs (NSAIDs) on the gastric mucosa and the prophylactic effects of misoprostol are both dose‐dependent. Aim: To investigate whether a low‐dose of misoprostol is sufficient to prevent gastric mucosal injury caused by low‐dose aspirin. Methods: We conducted a double‐blind placebo controlled parallel group endoscopic study in 32 evaluable volunteers. The main outcome measure was erosive injury (ulcers and superficial erosions) in the gastric mucosa over 28 days. Results: Most subjects developed erosions on aspirin 300 mg daily. This was significantly reduced by misoprostol 100 μg daily. (Odds ratio 0.18, 95% CI: 0.07–0.48). There were no drug‐related or gastrointestinal adverse events in subjects receiving misoprostol. Conclusion: Misoprostol 100 μg daily can prevent low‐dose aspirin induced gastric mucosal injury without causing identifiable adverse effects.

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