The recent report by Graham et al1 provides much needed insights into the comparative benefits of 2 gastroprotective therapies: misoprostol and the proton pump inhibitor lansoprazole. Clinicians are now especially eager for evidence-based guidance in the treatment of patients who have a history of endoscopically documented gastric ulceration without Helicobacter pylori infection and who require long-term therapy with a nonsteroidal anti-inflammatory drug (NSAID). However, the use of misoprostol (200 µg 4 times a day [800 µg/d], the maximum recommended dose) does not reflect the current realities of clinical practice.
Weaver AL, Gitlin N. Ulcer Prevention in Long-term Users of Nonsteroidal Anti-inflammatory Drugs. Arch Intern Med. 2002;162(19):2248-2249. doi: