Peptic Ulcer Disease, Cytoprotection, and Prostaglandins-Reply

In Reply.—Drs Lauritsen and RaskMadsen's letter to the editor correctly presents disappointing results of recent trials of various prostaglandin analogues for the treatment of peptic ulcer disease. The editorial and case report in the October 1988 issue of the Archives^1,2 did not propound prostaglandin analogues as the new therapeutic end-all for peptic ulcer disease. Rather, it discussed theoretical and physiologic mechanisms by which this multifactoral disease can be approached, and only suggested that "prostaglandin therapy has become a potentially promising new pharmacologic approach 'but' further clinical trials are anxiously awaited."¹ Prostaglandin analogues do, however, appear to be of therapeutic value in nonsteroidal anti-inflammatory druginduced gastropathy, where histamine² receptor blockers have been disappointing. Certainly, the potential for "abortion in a pill" and the frequently encountered diarrhea are major drawbacks to prostaglandin use without the appropriate indications.