Less Small-Bowel Injury With Lumiracoxib Compared With Naproxen Plus Omeprazole

A Novel Composite Endpoint to Evaluate the Gastrointestinal Effects of NSAID Through the Entire GI Tract: Introducing CSULGIE

“…The first human studies to suggest lower GI injury with NSAID employed indirect measures of damage including permeability changes and scanning of labelled neutrophils 12 . Capsule endoscopy supported these findings by associating mucosal erosions with NSAID 13,14 and showing a lower incidence with COX-2 inhibitors, while epidemiological studies and the results of some (but not most) outcome studies 15 pointed to a high rate of complicated lower GI events on NSAID that fell with COX-2 inhibitors.…”

Role of small-bowel endoscopy in the management of patients with inflammatory bowel disease: an international OMED–ECCO consensus

“…Within 2 weeks of taking NSAIDs, up to 75 % of patients may have small-bowel lesions [29,30]. Selective COX2-inhibitors cause fewer small-bowel lesions [31].…”

“…Some small-bowel lesions may be found in up to 75 % of NSAID users, even after 2 weeks' ingestion of such drugs [29,30]. Selective cyclooxygenase-2 (COX2) inhibitors are associated with small-bowel lesions less frequently than conventional NSAIDs [31]. Taking a thorough clinical history, including recent NSAID ingestion, is therefore essential to improve the predictive value of findings at SBCE (see also section 7.4.2).…”

1038 Cyclo-Oxygenase-2 Inhibitors or Nonselective NSAIDs Plus Gastroprotective Agents: What to Prescribe in Daily Clinical Practice?

“…10,30 However, results from other studies evaluating lower GI tract events as an outcome were conflicting. [31][32][33][34] A post hoc analysis of a prospective study showed a lower rate of serious lower GI events for rofecoxib compared to naproxen 30 , whereas this was not confirmed in a cross-sectional capsule enteroscopy study showing comparable small-bowel damage between long-term NSAID and coxib users. 34 Mechanistically, whether the impact of NSAIDs on lower GI events reflect a reduction in risk by coxib-use or an increase in risk by PPI-use due to altered intestinal bacteria and increased susceptibility to small intestinal bacterial overgrowth is still under debate.…”