Misoprostol for Aspirin-Induced Small Bowel Enteropathy: A Small Step in the Right Direction

Strategies to reduce the harm caused by cyclo-oxygenase (COX) inhibitors to the gastrointestinal (GI) tract continue to evolve. In this issue of Gastroenterology, Kyaw et al1 report on the benefit of misoprostol in decreasing clinically significant small intestinal lesions in patients receiving aspirin. This finding compliments several important recent randomized trials that have helped to refine our understanding of preventative strategies focused on the upper GI tract. The PRECISON study reported that, in patients with risk factors for cardiovascular disease, appropriately treated with a proton pump inhibitor (PPI), the COX-2 selective inhibitor celecoxib (up to a maximal dose of 100 mg twice daily) had comparable cardiovascular safety to the nonselective agents naproxen and ibuprofen, but a lower rate of clinically significant GI events.

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