A Cochrane review [Abstract] 1 included 41 studies on misoprostol, H2-receptor antagonists (H2RA), or proton pump inhibitors (PPI). All doses of misoprostol significantly reduced the risk of endoscopic ulcers. Misoprostol 800 µg/day was superior to 400 µg/day for the prevention of endoscopic gastric ulcdrs (RR = 0.17 and 0.39, respectively, p=0.0055). A dose response relationship was not seen with duodenal ulcers. Misoprostol caused diarrhea at all doses, although significantly more at the larger dose. Misoprostol also reduced the risk of clinical ulcer complications.
Standard doses of H2-antagonists were effective at reducing the risk of endoscopic duodenal (RR 0.36, 95% CI 0.18 to 0.74) but not gastric ulcers (RR 0.73, 95% CI 0.50 to 1.08). Both double dose H2-antagonists and proton pump inhibitors were effective at reducing the risk of endoscopic duodenal and gastric ulcers (RR 0.44, 95% CI 0.26 to 0.74, and RR 0.40, 95% CI 0.32 to 0.51 respectively for gastric ulcer) and both were better tolerated than misoprostol.
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