arbaprostil and Gastritis

Twenty-nine outpatients chronically ingesting daily aspirin or nonsteroidal antiinflammatory drugs for rheumatological disease, who had endoscopically proven gastric mucosal lesions worse than erythema, were evaluated for 4 wk in a randomized, double-blind trial comparing 15(R)-15-methyl prostaglandin E2 (Arbacet) (10 micrograms, 0.5 h before each meal and at bedtime) with placebo. Patients continued their usual daily dose of antiarthritic medication throughout the study period, and an endoscopy was performed on the final day to assess healing. Five of 14 patients (36%) taking Arbacet and two of 15 patients (13%) in the placebo group had complete healing of their gastric lesions after 4 wk. Arbacet at a daily dose of 40 micrograms is not significantly better than placebo in healing gastric lesions caused by aspirin or nonsteroidal antiinflammatory drugs, if antiinflammatory therapy is continued.

Topics: Anti-Inflammatory Agents, Non-Steroidal; Arbaprostil; Aspirin; Clinical Trials as Topic; Double-Blind Method; Female; Gastric Mucosa; Gastritis; Gastroscopy; Humans; Male; Middle Aged; Prospective Studies; Prostaglandins E, Synthetic; Random Allocation; Wound Healing

Topics: Adult; Aged; Arbaprostil; Arthritis, Rheumatoid; Aspirin; Female; Gastric Mucosa; Gastritis; Humans; Indomethacin; Male; Middle Aged; Prostaglandins E, Synthetic

A 19-yr-old male developed severe hemorrhagic gastritis following three abdominal operations. Treatment with intravenous cimetidine and hourly antacids to maintain his gastric pH above 5 failed to affect gastrointestinal bleeding. Also, peripheral venous vasopressin, propantheline bromide, and glucagon were without effect. Total gastrectomy was considered to control his bleeding. However, since a number of prostaglandin analogs prevent gastric lesions produced by many noxious agents (e.g., aspirin, alcohol, strong acid or alkali, etc.) in animals and humans, the patient was treated with 50 micrograms of 15(R)-15 methyl prostaglandin E2 intragastrically every 6 h for 10 days. To epimerize the 15(R) form to the more active 15(S) form, 50-100 ml of 50-mN HCl was placed into the patient's stomach immediately before each dose. Bleeding ceased within 24 h of the onset of 15(R)-15 methyl prostaglandin E2 therapy and did not recur. The prompt response to 15(R)-15 methyl prostaglandin E2 in combination with hourly antacids in this patient with persistent and severe hemorrhagic gastritis suggests a therapeutic effect and the need for a prospective double-blind clinical trial.

Topics: Abdomen; Administration, Oral; Adult; Arbaprostil; Gastritis; Gastrointestinal Hemorrhage; Humans; Male; Postoperative Complications; Prostaglandins E, Synthetic