Prevention of nonsteroidal anti-inflammatory drug-induced small-intestinal injury by prostaglandin: a pilot randomized controlled trial evaluated by capsule endoscopy

Background: There is no known preventive agent against nonsteroidal anti-inflammatory drug (NSAID) induced small-intestinal injury. Objective: To evaluate by capsule endoscopy whether coadministration of prostaglandin (PG) can prevent small-intestinal damage induced by short-term NSAID treatment. Design: Single-blind, randomized, controlled trial. Setting: All procedures were performed at Nippon Medical School. Subjects: Thirty-four healthy male Volunteers. Methods: All subjects were randomly assigned to 2 groups: an NSAID-control group, who underwent NSAID (diclofenac sodium, 25 mg 3 times daily) and omeprazole (20 mg once daily) treatment, and an NSAID-PG group, who received PG (misoprostol, 200 mu g 3 times daily) in addition to the same NSAID-omeprazole treatment. Eligible Subjects, 15 per group, underwent capsule endoscopy before and 14 days after treatment. Main Outcome Measurements: The number of mucosal breaks at capsule endoscopy. Results: NSAID treatment significantly increased the mean (SD) number of mucosal breaks per subject, from a basal level of 0.1 +/- 0.3 up to 2.9 +/- 6.3 lesions in the NSAID-control group (P = .012). In contrast, there was no significant change in the mean number of mucosal breaks before and after PG cotreatment (P = 0.42). Thus, the mean number of posttreatment mucosal breaks per subject was significantly higher in the NSAID-control group than in the NSAID-PG group (P = .028). There was a significant increase in the percentage of subjects in the NSAID-control group, with at least I mucosal break after treatment (from 6.7% to 53.3%), whereas there was no change in the incidence of mucosal breaks in the NSAID-PG group, which remained at 13.3%. (P = .002). Limitations: Single-center, open-label study. Conclusions: PG cotherapy reduced the incidence of small-intestinal lesions induced by a 2-week administration of diclofenac sodium. (Gastrointest Endosc 2009;69:1339-46.)