Endoscopic comparison of cimetidine and sucralfate for prevention of naproxen-induced acute gastroduodenal injury

Abstract

Nonsteroidal antiinflammatory drug-induced gastroduodenal mucosal damage observed endoscopically is usually categorized as hemorrhages, erosions, or ulcerations. We undertook this study to determine whether the injury produced by a commonly prescribed NSAID, naproxen, could be reduced by cotherapy with sucralfate or cimetidine and to determine how dependent the differences in the degree of protection against mucosal injury measured were on the scoring system used. Four groups of 20 healthy volunteers with endoscopically normal gastric and duodenal mucosa received naproxen (500 mg twice a day) plus cimetidine (300 mg four times a day or 400 mg twice a day), sucralfate (1 g four times a day), or placebo for seven days. After seven days of therapy, a second endoscopy was performed. Separate scoring systems were used for the presence of hemorrhages, erosions, and a combination of both types of injury. There were significantly fewer mucosal hemorrhages present when naproxen and cimetidine were administered than when naproxen was administered with placebo or sucralfate (placebo vs 300 mg cimetidine, P = 0.04, and placebo vs 400 mg cimetidine, P = 0.006, placebo vs sucralfate, P = 0.26). Both cimetidine dosages resulted in significantly fewer hemorrhages than were present following cotherapy of naproxen and sucralfate (P less than 0.05). In contrast, there was no discernible difference in the mucosal injury between placebo and any drug or between any two active therapies when the injury was evaluated based on the presence of gastric erosions.(ABSTRACT TRUNCATED AT 250 WORDS)

Endoscopical appearances of nonsteroidal anti inflammatory drug (NSAID)- enteropathy

“…[1][2][3][4][5][6][7][8][9][10][11][14][15][16][17][18] The data from this study shows the side effects of NSAID in stomach, duodenum and jejunum. All of the patients (100%) were found to have NSAID gastropathy endoscopically, in which hyperemia 100%, erosions 97.4% and ulcer 26.3% were seen.…”

“…11,12 The endoscopic appearance of the NSAID entero-gastropathy were hyperemia, erosion and ulcer. Hyperemia was graded as normal, mild, moderate and severe.…”

“…12,13 The dyspeptic symptoms were epigastric pain, nausea, vomiting, bloating, and anorexia. The grading system was made quantitatively as none (0), mild (1-5), moderate (6-10), severe (11)(12)(13)(14)(15). Epigastric pain: 0 (none); 1 (mild) if the pain was rare, not severe, 1-2 x/day and absent if the patient did not think about the symptom; 2 (moderate) if the pain occurred more than 2x/day, clearly, but did not disturb the daily activity; 3 (severe) if the pain occurred continuously, disturbed the daily activity or bedrest was needed to relieve the symptom.…”

Misoprostol—a Logical Therapeutic Approach to Gastroduodenal Mucosal Injury Induced by Non-Steroidal Anti-Inflammatory Drugs?

“…I n another study cimetidine prevented gastritis and duodenitis but not erosive lesions (102). This lack of effect on clinically meaningful mucosal injury (defined (103) as actual breaks in the mucosa) has been confirmed recently in a placebocontrolled study in which both cimetidine and sucralfate failed to produce a reduction in erosions or ulcers (103).…”

Increased Gastric Mucus Secretion Alleviates Non-Steroidal Anti-Inflammatory Drug-Induced Abdominal Pain

“…The grade of gastric mucosal injury was assessed based on the modified Lanza score (MLS) (Lanza et al 1990;Iijima et al 2011). In the present analysis, the scoring system was based on the number of erosions and/or ulcers regardless of the presence or absence of hemorrhaging, because petechial hemorrhages are generally of little clinical significance (Feldman et al 2001).…”