The natural history of chronic
antral gastritis in relation to the healing of
duodenal ulcer and its response to treatment, if any, are unknown. We performed a double-blind controlled trial using an oral
prostaglandin E1,
misoprostol, in 229 patients with active
duodenal ulcer randomized to receive placebo (n = 76),
misoprostol 200 micrograms (n = 77), or
misoprostol 300 micrograms (n = 76), q.i.d. orally. Healing of
duodenal ulcer was assessed biweekly up to 12 wk by endoscopy, during which procedures at least two
antral and two fundal biopsy specimens were taken. The activity and the degree of chronic
inflammation of
gastritis, as assessed histologically by the infiltration of polymorphs and chronic inflammatory cells, respectively, was graded blindly by two pathologists as nil, mild, moderate, or severe. Before treatment, 99% of patients had chronic
antral gastritis and 1.5% had chronic fundal
gastritis. In the placebo group, healed
duodenal ulcer was associated with significantly (p less than 0.01, life table analysis) higher incidence of improvement of the activity of the
antral gastritis (nil or mild as endpoint) than unhealed
ulcer (30% vs. 4% at week 8). Irrespective of whether
duodenal ulcer was healed or unhealed, significantly (p less than 0.01) more patients on
misoprostol (50% at week 8) showed improvement (nil or mild as endpoint) than the placebo group. The degree of chronic
inflammation of the
antral gastritis showed similar significant changes in favor of
misoprostol. Smoking and alcohol intake had no significant effect on the improvement of chronic
antral gastritis. In conclusion, healing of
duodenal ulcer was associated with improvement of the activity of chronic
antral gastritis, which, as shown for the first time, could be further enhanced by a therapeutic agent--
prostaglandin E1.