NSAID-induced peptic ulcer disease can be prevented by which cytoprotective agent?

• A. Misoprostol
• B. Omeprazole
• C. Ranitidine
• D. Bismuth Subsalicylate

Answer: (A)

NSAIDs strip away protective prostaglandins in the gastric mucosa, tipping the balance toward injury and ulcer formation. A cytoprotective approach aims to replace those prostaglandin effects to defend the lining. Misoprostol acts as a prostaglandin E1 analog, boosting mucus and bicarbonate production, supporting mucosal blood flow, and reducing susceptibility to acid injury. This restoration of mucosal defenses is why misoprostol is the go-to agent for preventing NSAID-induced peptic ulcers. While acid-suppressing drugs like omeprazole or ranitidine reduce injury by lowering acid, they don’t restore the mucosal protective mechanisms that NSAIDs blunt. Bismuth subsalicylate offers some mucosal protection but isn’t the standard preventive cytoprotective agent for NSAID-related ulcers. Be mindful of misoprostol’s side effects (e.g., diarrhea) and its contraindication in pregnancy due to uterotonic effects.