Anti-ulcer drugs in antisecretory doses for "cytoprotection" in arthritic patients?

Gastric injury and dyspepsia are major side-effects of acetylsalicylic acid (ASA) or most non-steroidal anti-inflammatory drugs (NSADs) which cause either gastric ulcerations or gastroduodenal erosions. There is only a limited number of trials in which the possibility of preventing or treating gastric lesions due to those drugs have been studied in man. This paper reviews trials in which H2-receptor antagonists, pirenzepine and prostaglandins have been investigated. - Pirenzepine given in antisecretory doses seems to improve gastrointestinal symptoms induced by ASA or NSADs. Cimetidine and misoprostol might prevent fecal blood loss. Gastroduodenal lesions might be prevented by pirenzepine, misoprostol and enprostil. It might be possible that cimetidine or ranitidine heal NSAD-induced peptic ulcers better than placebo in arthritic patients who stop the ingestion of NSADs. - All over the results of the cited trials are inconclusive, since the number of patients studied were too small and the design of almost all trials was incomparable. Furthermore, all cited studies do not correspond to Robert's concept of "cytoprotection", since H2-blockers, pirenzepine and prostaglandins have been applied in antisecretory doses in man.