Cyclooxygenase-2 inhibitors in patients with high gastrointestinal risk: are we there yet?
Gastrointestinal complications from the use of nonsteroidal antiinflammatory drugs (NSAIDs) are common and costly. Cyclooxygenase (COX)-2 inhibitors cause fewer gastrointestinal events than nonselective NSAIDs but may still result in peptic ulcer complications in a significant proportion of high-risk patients. The risk can be further reduced by prescribing COX-2 inhibitors together with proton pump inhibitors. Small-bowel injury is also commonly seen in long-term users of COX-2 inhibitors. The potential cardiovascular side effects of most COX-2 inhibitors and NSAIDs pose great challenge to physicians. Further studies are required to optimize the treatment regimen in patients with high cardiovascular and gastrointestinal risk and to decide the best treatment options for patients with small- and large-bowel complications.
Wong
Vincent Wai-Sun
VW
Department of Medicine and Therapeutics and Institute of Digestive Disease, The Chinese University of Hong Kong, 9/F, Prince of Wales Hospital, 30-32 Ngan Shing Road, Shatin, Hong Kong, People's Republic of China.
Chan
Francis Ka-Leung
FK
D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects*; D002318:Cardiovascular Diseases / Q000139:chemically induced; D002986:Clinical Trials as Topic; D052246:Cyclooxygenase 2 Inhibitors / Q000009:adverse effects*; D005767:Gastrointestinal Diseases / Q000139:chemically induced* / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D012307:Risk Factors
D000894:Anti-Inflammatory Agents, Non-Steroidal; D052246:Cyclooxygenase 2 Inhibitors; D054328:Proton Pump Inhibitors