Clinical research studyCelecoxib compared with lansoprazole and naproxen to prevent gastrointestinal ulcer complications
Section snippets
Study population
We screened patients, aged 18 years or older, who were admitted to the departments of medicine or surgery with upper GI bleeding while receiving NSAIDs. Endoscopy was performed within 24 hours after admission. Patients were recruited into the study if gastric and/or duodenal ulcer, defined as a break in the mucosa of at least 5 mm in diameter with unequivocal depth, was found on endoscopy and they had diseases (eg, osteoarthritis, rheumatoid arthritis) that were expected to require continuous
Characteristics of patients
A total of 376 patients with peptic ulcer bleeding while taking NSAIDs were screened for eligibility into the trial. Of these, 134 patients were excluded (Figure 1): 5 had erosions only on upper endoscopy, 5 failed endoscopic hemostasis, 9 declined to participate, 33 were taking concomitant aspirin or warfarin, 2 had previous gastric surgery, 2 had carcinoma of stomach on histology, 4 had active malignancy, 52 had abnormal laboratory findings (48 had elevated serum creatinine levels), 19 did
Discussion
Proton pump inhibitor co-therapy has been shown to reduce relapse of endoscopic peptic ulcers and peptic ulcer complications in patients receiving NSAIDs.3, 4 However, a small proportion of patients still developed relapse of ulcer bleeding after continued use of NSAIDs and proton pump inhibitor. The efficacy of proton pump inhibitor co-therapy may also be reduced in the absence of H. pylori infection.11
Recent studies suggest that selective COX-2 inhibitors have effective anti-inflammatory
Conclusion
Celecoxib was as effective as lansoprazole co-therapy in the reduction of ulcer complication recurrences in subjects with a history of NSAID-related peptic ulcers. However, celecoxib, similar to lansoprazole co-therapy, was still associated with a significant proportion of ulcer complication recurrences. In addition, more patients receiving celecoxib developed dyspepsia than did patients receiving lansoprazole and naproxen.6
Acknowledgment
We are indebted to Drs. Chi Kuen Chan, Chi Kin Hui, and Ka Fai Kwok for recruiting the patients and performing the endoscopy; to endoscopy nurses at the Queen Mary Hospital for their assistance; to Ms. April Wong for data management; and to Mr. Stanley Yeung for statistical calculations.
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The study was supported by Peptic Ulcer Research Fund and Simon K.Y. Lee Gastroenterology Research Fund of the University of Hong Kong.