Improvement of intestinal metaplasia six month after misoprostol treatment

O. Leri, F. Fiocca*, M. Mastropasqua, T. Losi, S. Tubili, P. Perinelli, E. Grasso*, G. Scopelliti, D. De Luca

Dipartimento di Malattie Infettive e Tropicali, *II Clinica Chirurgica, “La Sapienza” University – Rome (Italy)

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• Gastroenterology

Abstract. – Purpose: To establish whether misoprostol (a synthetic prostanoid) is effective in improving intestinal metaplasia of dyspeptic patients. Patients: Of the 206 dyspeptic patients without Helicobacter pylori, 18 (7.1%) had histological evidence of intestinal metaplasia (2 presented mild metaplasia, 9 moderate and 7 severe). They were treated with misoprostol 200 mg twice daily for six months and, after stopping the treatment, they all underwent endoscopic control. Results: There was a statistical significant improvement of intestinal metaplasia (p<0.001) and of the activity of antral gastritis (p= 0.03). There were no significant changes in antral and body specimens during follow-up. Discussion: Though the small number of the patients and the lack of control group, our results suggest that misoprostol allows regression and/or improvement of histological IM (p< 0.001). It has proved to be effective in prevention of both gastric and duodenal ulcers induced by NSAID therapy, probably related largely to replacement of endogenous prostaglandins inhibited by the use of NSAID and it may also exerts its protective effects through inhibition of gastric acid secretion. Moreover, misoprostol showed to increase the rate of gastric blood flow, inducing a mucosal protective effect against the factors damaging gastric mucosa. It has been also documented that misoprostol regulates inflammatory cytokines and prolonged the survival of transplants, reflecting both its immunosuppressive and anti-inflammatory effect. In conclusion, since intestinal metaplasia increases the risk of gastric cancer, the use of misoprostol, in this pathology, would be of some interest.

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