Improvement of intestinal metaplasia six month after misoprostol treatment.

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 evi- dence 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 im- provement 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 pa- tients 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 endoge- nous prostaglandins inhibited by the use of NSAID and it may also exerts its protective effects through inhibition of gastric acid secretion. Moreover, miso- prostol 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 regu- lates inflammatory cytokines and prolonged the survival of transplants, reflecting both its immuno- suppressive and anti-inflammatory effect. In con- clusion, since intestinal metaplasia increases the risk of gastric cancer, the use of misoprostol, in this pathology, would be of some interest.