Deficiency of prostaglandins (PGs) by non-steroidal anti-inflammatory drugs (NSAIDs) causes a loss of gastroduodenal mucosal integrity, leading to development of ulceration. PG derivatives such as misoprostol and enprostil have been proven effective in prevention and treatment of NSAIDs-induced gastroduodenal ulcers. Although side effects such as diarrhea limit the use of PG derivatives, the efficacy of these drugs in NSAIDs-induced injuries is approximately equal to that of proton pump inhibitors. Mucoprotective drugs such as rebamipide also have been reported to be effective for prevention of NSAIDs-induced ulcers. Since misoprostol and some mucoprotective drugs can prevent NSAIDs-induced small intestinal injuries, these drugs, especially misoprostol, should be used as first-line therapy for NSAIDs-induced gastrointestinal injuries with attention paid to the side effects.
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