The efficacy of
antacids in the short- and long-term treatment of
peptic ulcers, has suggested a possible use in the prevention and in the treatment of non-steroidal anti-inflammatory
drug related gastroduodenal lesions. In short-term prevention studies, significant protection against ASA-related lesions was observed when
antacids at high-dose were given before the administration of the offending
drug. To the contrary,
antacids at low dose did not prevent ASA-induced lesions of gastric and duodenal mucosa. As for long-term prophylaxis, no clinical effect was observed. In the treatment of non-steroidal anti-inflammatory
drug-related mucosal lesions in patients who were able to discontinue the offending drugs,
antacids proved of some use, when compared with placebo, but were significantly less effective than H2 blockers, as
cimetidine.
Sucralfate is an effective antiulcer
drug thought to provide cytoprotective action. Although initial studies utilizing
sucralfate for protection against short-term
aspirin administration were encouraging, longer term studies (more than 7 days) were generally disappointing. A comparative study with
misoprostol demonstrated that the
PGE1 analogue was far superior for the prevention of non-steroidal anti-inflammatory drugs
ulcers, and that ulceration rates in the
sucralfate group were equivalent to rates in the placebo group. As far as the treatment of non-steroidal anti-inflammatory
drug-related mucosal lesions is concerned,
sucralfate proved superior to placebo, similar to
ranitidine, but significantly less effective than
omeprazole.