Long-term celecoxib can prevent the progression of persistent gastric intestinal metaplasia After H. pylori eradication.
OBJECTIVE
Intestinal metaplasia (IM) has overexpressions of COX-2. Short-term 8-week celecoxib, a selective COX-2 inhibitor, exerts a preliminary hint to improve regression in part for persistent IM after Helicobacter pylori eradication. This study further validated whether or not a prolonged duration of celecoxib of up to 1 year can be safe and effective.


METHODS
One hundred and forty patients, with persistent IM after H. pylori eradication for 1 year, were included with half of them receiving celecoxib 200 mg/day for 12 months and the other half serving as controls. Each patient received serial checkups of blood creatinine levels every 4 months. After the 1-year follow-up, panendoscopy was repeated to assess the IM regression. The serial gastric specimens, taken before and after celecoxib therapy, were immunochemically stained for COX-2.


RESULTS
The intention-to-treat (ITT) and per-protocol (PP) analyses to the rates of IM regression were higher in the celecoxib group than in the controls (ITT: 44.3% [31/70] vs 14.3% [10/70], p < .001; and PP: 51.7% [31/60] vs 16.1% [10/62], p < .001). All enrolled patients had no renal impairment during follow-up. Even in the patients without IM regression, the mean IM scores and COX-2 expressions were significantly more decreased in the celecoxib group than in the controls (p < .005).


CONCLUSIONS
One year 200-mg celecoxib daily be safely administered to improve the regression or prevent the progression of persistent IM after H. pylori eradication.
Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan. sheubs@mail.ncku.edu.tw
Bor-Shyang
BS
Sheu
Yu-Ching
YC
Tsai
Chung-Tai
CT
Wu
Wei-Lun
WL
Chang
Hsiu-Chi
HC
Cheng
Hsiao-Bai
HB
Yang
D000328:Adult; D000068579:Celecoxib; D052246:Cyclooxygenase 2 Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D005757:Gastritis, Atrophic / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D007422:Intestines / Q000382:microbiology / Q000473:pathology*; D008297:Male; D008679:Metaplasia / Q000188:drug therapy* / Q000382:microbiology / Q000473:pathology; D008875:Middle Aged; D011720:Pyrazoles / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D013449:Sulfonamides / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D016896:Treatment Outcome
D052246:Cyclooxygenase 2 Inhibitors; D011720:Pyrazoles; D013449:Sulfonamides; D000068579:Celecoxib