Do Cyclooxygenase-2 Inhibitors Provide Benefits Similar to Those of Traditional Nonsteroidal Anti-Inflammatory Drugs, with Less Gastrointestinal Toxicity?

Article Abstract:

The use of the cyclooxygenase-2 (COX-2) inhibitors celecoxib and rofecoxib seem to be involved with fewer ulcers and ulcer complications than the traditional non-steroidal anti-inflammatory drugs (NSAIDs). these drugs were designed to block COX-2 but not COX-1, and would therefore retain the desired anti-inflammatory properties but would not inhibit the synthesis of gastrointestinal prostaglandins (thereby avoiding ulcers) and platelet thromboxane (thereby avoiding bleeding). Gastrointestinal ulcers and bleeding are recognized side effects of traditional NSAIDs that block COX-1 and COX-2. The COX-2 inhibitors have proven to be as effective as NSAIDs in terms of anti-inflammatory ability.

Evaluation, COX-2 inhibitors

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Nonsteroidal anti-inflammatory drug use and increased risk for peptic ulcer disease in elderly persons

Article Abstract:

The use of the pain relievers known as nonsteroidal anti-inflammatory drugs has been associated with an increased risk of peptic ulcer disease and upper gastrointestinal bleeding. To study the specific degree of risk for ulcer disease and to determine what association might exist between drug dose, duration of use and peptic ulcer disease, 1,415 patients with known ulcers or gastrointestinal bleeding were compared with 7,063 control subjects without ulcer disease. The study patients were Medicaid recipients over the age of 65 who were hospitalized with documented peptic ulcer disease or bleeding, whose records were studied for evidence of nonsteroidal anti-inflammatory drug therapy. Current use of a nonsteroidal anti-inflammatory drug was found in 34 percent of patients with ulcer disease, compared with 13 percent of controls. The risk of peptic ulcer disease was found to be greater with increasing doses as well as with shorter duration of therapy (less than 30 days). When factors such as age, sex, race, and recent hospitalizations were considered, users of nonsteroidal anti-inflammatory drugs were shown to be at greater risk for peptic ulcer disease than control subjects. One drug, ibuprofen, carried a lower risk than several of the other anti-inflammatory drugs, but the dose of ibuprofen studied was less than that generally prescribed, so no conclusion about greater safety in the use of ibuprofen should be inferred. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ibuprofen, Peptic ulcer

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Can gastroduodenal ulcers in NSAID users be prevented?

Article Abstract:

Misoprostol may prevent gastroduodenal ulcers in individuals treated with non-steroidal anti-inflammatory drugs (NSAID) such as aspirin. Gastroduodenal ulcers occur in the stomach and the duodenal segment of the small intestine. Nonsalicylate NSAIDs decrease the production of prostaglandin. This can cause the development of ulcers and life-threatening complications such as gastrointestinal bleeding or perforation. The most effective method for preventing these complications is to avoid the use of NSAIDS, but this might not always be possible. Patients with osteoarthritis or rheumatoid arthritis may need to use nonsalicylate NSAIDs to decrease inflammation. Three research studies found that misoprostol decreased the risk of a stomach ulcer in arthritis patients treated with NSAIDS. Consolidation of the data from the three studies found that misoprostol also protected against duodenal ulcers.

Health aspects, Editorial, Prevention, Misoprostol

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