Protective effects against alcohol insult: does somatostatin play any role?

This study evaluated the cytoprotective properties of misoprostol, a synthetic prostaglandin E1 analogue and cimetidine, against alcohol-induced gastric mucosal injury and examined the role of increased gastric juice somatostatin in cytoprotection. Forty-give healthy adult male volunteers were enrolled in a randomized, double-blind, placebo-controlled endoscopic study. Screening endoscopy was done to exclude subjects with asymptomatic gastric mucosal abnormality. Misoprostol (200 micrograms) intragastrically, cimetidine (300 mg) orally or placebo were administered prior to ethanol challenge. Injury to the gastric mucosa was produced by spraying it with 80% ethanol solution instilled intragastrically. Endoscopic evaluation of gastric mucosa was conducted 15 and 30 minutes after ethanol by two endoscopists independently according to a seven-point scale. Thirty minutes following the instillation of ethanol, gastric contents were aspirated and analysed for immunoreactive somatostatin. The gastric mucosa of placebo-treated subjects showed marked damage with endoscopic score (mean +/- standard deviation) of 5.5 +/- 0.9. Cimetidine partially prevented gastric mucosal damage with endoscopic score of 4.5 +/- 1.7 as compared to placebo (P = 0.04). Misoprostol prevented significant gastric mucosal injury, (endoscopic score of 1 +/- 1.7) when compared to placebo (P = 0.0001) and to cimetidine (P = 0.0002). The gastric juice somatostatin concentration (pg/ml) was 75.79 +/- 13.59 in the misoprostol group, 64.71 +/- 8.06 in the cimetidine group and 34.34 +/- 5.66 in the placebo group. Both misoprostol and cimetidine showed significant (P = 0.05) increase in gastric juice somatostatin when compared to placebo treatment. The degree of gastric mucosal protection afforded by misoprostol was significantly greater than cimetidine. Since gastric juice somatostatin in the misoprostol group was not significantly different from the cimetidine group, it was concluded that gastric juice somatostatin is not solely responsible for the cytoprotective ability of misoprostol.