Celecoxib Versus Naproxen for Prevention of Recurrent Ulcer Bleeding in Arthritis Patients

Nonsteroidal anti-inflammatory drugs (NSAIDs) are the most commonly consumed drugs worldwide for the relief of pain and arthritis. However, the use of NSAIDs increases the risk of ulcer bleeding by 4-fold. Current evidence indicates that combination of conventional NSAIDs and a proton pump inhibitor (PPI) reduces the risk of ulcer complications. The alternative strategy is to replace conventional, non-selective NSAIDs with NSAIDs selective for cyclooxygenase-2 (COX-2 inhibitors). Recently, there are concerns about the cardiovascular safety of COX-2 inhibitors and conventional NSAIDs. Because of such concern, patients requiring anti-inflammatory analgesics who have cardiovascular risk factors (e.g. smoking, hypertension, hyperlipidemia, diabetes) should receive prophylactic low-dose aspirin. However, concomitant low-dose aspirin negates the gastric sparing effect of COX-2 inhibitors and augments the gastric toxicity of nonselective NSAIDs. Thus, gastroprotective agents such as PPIs should be co-prescribed to patients with high ulcer risk who are taking aspirin plus a COX-2 inhibitor or a nonselective NSAID.

Inclusion criteria

• age >18,
• a history of endoscopically proven gastroduodenal ulcer bleeding,
• H. pylori negative
• a history of cardiothrombotic disease requiring ASA, and
• anticipated regular use of NSAIDs for the duration of trial

Exclusion criteria

• concomitant use of anticoagulants;
• a history of gastric or duodenal surgery other than a patch repair;
• the presence of erosive esophagitis,
• gastric outlet obstruction,
• renal failure (defined by a serum creatinine level of more than 200 umol/L),
• pregnancy,
• terminal illness, or
• cancer