[Gastroduodenal safety of selective inhibitors of cyclooxigenase-2: practical validation].
OBJECTIVE
To evaluate rate of erosions and ulcers of the upper gastroduodenal tract (UGDT) in patients treated with selective cyclooxigenase inhibitors (C-NAID).


METHODS
A retrospective analysis of esophagogastroduodenoscopies made in the Institute of Rheumatology in 2002-2004 was made for two groups. The study group received C-NAID (nimesulid, n = 330; meloxicam, n = 371; celecoxib, n = 66), the control group--diclofenak (n = 1935). The groups were matched by age, gender and concomitant therapy. Incidence of ulcers in the past was significantly higher in the study group.


RESULTS
Occurrence of erosions and ulcers in the study and control groups was comparable: 22.4, 24.5, 21.2 and 27.6%, respectively. Multiple erosions (ME, n > 10) and ulcers significantly less frequently occurred in the study group: 8.8, 10.5, 10.6 and 14.6%, respectively (p < 0.05). Significant difference in occurrence of erosions and ulcers in UGDT for different C-NAID was not found. ME and ulcers in patients with ulcer anamnesis were recorded less frequently in intake of C-NAID than diclofenak (22.5 and 46.2%, resopectively, p < 0.001).


CONCLUSIONS
Selective inhibitors of COG-2 are not safe enough in relation to gastrointestinal pathology, especially in patients with ulcer anamnesis. Nimesulid, meloxicam and celecoxibe were comparable in respect to detectability of gastrointestinal erosions and ulcers.
Karateev
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AE
D000328:Adult; D000368:Aged; D051546:Cyclooxygenase 2; D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors / Q000009:adverse effects* / Q000494:pharmacology / Q000627:therapeutic use; D004381:Duodenal Ulcer / Q000139:chemically induced* / Q000175:diagnosis; D004384:Duodenoscopy; D004386:Duodenum / Q000187:drug effects / Q000473:pathology; D005260:Female; D005773:Gastroscopy; D006801:Humans; D008297:Male; D008565:Membrane Proteins; D008875:Middle Aged; D011451:Prostaglandin-Endoperoxide Synthases / Q000378:metabolism*; D012216:Rheumatic Diseases / Q000188:drug therapy*; D013270:Stomach / Q000187:drug effects / Q000473:pathology; D013276:Stomach Ulcer / Q000139:chemically induced* / Q000175:diagnosis
D052246:Cyclooxygenase 2 Inhibitors; D016861:Cyclooxygenase Inhibitors; D008565:Membrane Proteins; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D011451:Prostaglandin-Endoperoxide Synthases