Short-term celecoxib to regress long-term persistent gastric intestinal metaplasia after Helicobacter pylori eradication.
OBJECTIVE
The intestinal metaplasia (IM) has overexpressions of cyclooxygenase-2 (COX-2) and beta-catenin. This pilot study assessed whether celecoxib, a selective COX-2 inhibitor, could regress IM that persisted long term after Helicobacter pylori eradication.


METHODS
Thirty-three patients with H. pylori eradication were enrolled in the present study due to the persistence of IM after a 3-year follow up. These patients received celecoxib 200 mg/day for 8 weeks, and were serially checked for levels of blood urea nitrogen and creatinine once per 2 weeks. After 8-week celecoxib treatment, IM regression was assessed by panendoscopy. The gastric specimens, taken before and after celecoxib, were immunochemically stained for COX-2 and beta-catenin.


RESULTS
The intention-to-treat and per-protocol analyses to the rates of IM regression by 8-week celecoxib treatment were 24.2% (8/33) and 28.6% (8/28), respectively. All enrolled patients had no renal impairment. Even in the patients without total IM regression, mean IM scores in the antrum decreased after 8-week celecoxib treatment (P = 0.007). The patients with complete regression of IM after 8-week celecoxib treatment had a significantly lower COX-2 expression, but not beta-catenin expression, at enrollment than those patients without IM regression (P = 0.031).


CONCLUSIONS
Short-term celecoxib treatment can be safe and promising to regress long-term persistent IM after H. pylori eradication.
Hung
Kuei-Hsiang
KH
Institute of Basic Medical Sciences, National Cheng Kung University, Hsinchu, Taiwan.
Yang
Hsiao-Bai
HB
Cheng
Hsiu-Chi
HC
Wu
Jiunn-Jong
JJ
Sheu
Bor-Shyang
BS
D000368:Aged; D001284:Atrophy; D015415:Biomarkers / Q000097:blood; D001806:Blood Urea Nitrogen; D000068579:Celecoxib; D003404:Creatinine / Q000097:blood; D051546:Cyclooxygenase 2 / Q000378:metabolism; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D004334:Drug Administration Schedule; D005260:Female; D005753:Gastric Mucosa / Q000187:drug effects* / Q000201:enzymology / Q000382:microbiology / Q000473:pathology; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016480:Helicobacter pylori / Q000472:pathogenicity*; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008679:Metaplasia; D008875:Middle Aged; D010865:Pilot Projects; D011720:Pyrazoles / Q000008:administration & dosage* / Q000009:adverse effects; D013449:Sulfonamides / Q000008:administration & dosage* / Q000009:adverse effects; D013997:Time Factors; D016896:Treatment Outcome; D051176:beta Catenin / Q000378:metabolism
D015415:Biomarkers; C495270:CTNNB1 protein, human; D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D051176:beta Catenin; D003404:Creatinine; D051546:Cyclooxygenase 2; C496540:PTGS2 protein, human; D000068579:Celecoxib