Misoprostol-induced increases in adherent gastric mucus thickness and luminal mucus output.

Gastroduodenal mucus can be separated into two phases: insoluble mucus gel adherent to the mucosal surface, and luminal mucus, which is removed by washing out the lumen. The adherent mucus gel is part of the mucosal protective barrier to acid and pepsin in the gastric juice. Luminal mucus, which is mobile, probably does not significantly protect against gastric juice, but functions as a lubricant, protecting the adherent mucus layer and underlying mucosa from mechanical damage. Adherent mucus is observed on the mucosal surface as a thin, continuous, gelatinous layer of variable thickness, about 50-450 microns (median, 180 microns) in man and 10-230 microns (median 80 microns) in the rat. Thickness of this adherent mucus layer in the rat stomach is increased significantly (up to threefold) following topical administration of misoprostol in vivo 1 hr before measurement. Simultaneous increases are observed in the content of luminal mucus following misoprostol administration. Seventy percent of maximum response is observed within 5 min of topical prostaglandin administration, compatible with the release of preformed mucus. Such prostaglandin-stimulated increases in mucus thickness will improve the protective capacity of the adherent mucus gel. The thickness of the adherent mucus layer is not changed following topical exposure, in vivo 1 hr before measurement, to exogenous mucosal-damaging agents (eg, ethanol, indomethacin and taurocholate. However, since such damaging agents permeate the mucus gel, it appears to offer little initial protection to the underlying epithelium. The mucus barrier primarily guards against the natural aggressors acid and pepsin, protecting the epithelium and its repair following acute mucosal damage.