title: Amelioration of small bowel injury by switching from nonselective nonsteroidal anti-inflammatory drugs to celecoxib in rheumatoid arthritis patients: a pilot study.
abstract: OBJECTIVE
  Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in patients with rheumatoid arthritis (RA) but have several side effects including mucosal damage in the small intestine. We aimed to evaluate whether the small bowel injury is ameliorated by switching from nonselective NSAIDs to celecoxib in patients with RA.
  
  
  METHODS
  Sixteen patients with RA who were treated with nonselective NSAIDs were enrolled in this study. Nonselective NSAIDs were converted to celecoxib for 12 weeks. Capsule endoscopy was performed before and after treatment with celecoxib. Videos were screened by gastroenterologists blinded to the patients' treatment.
  
  
  RESULTS
  Before the administration of celecoxib, reddened folds, denuded areas, petechiae/red spots and mucosal breaks were observed in 63, 63, 88 and 69% of the patients, respectively. In the 14 patients who completed this study, conversion to celecoxib significantly reduced the number of petechiae/red spots, the number of mucosal breaks, and Lewis scores. RA activity and cytokine levels in the peripheral blood were not significantly different before and after treatment with celecoxib.
  
  
  CONCLUSIONS
  The incidence of small bowel injury by nonselective NSAIDs is high in patients with RA. Conversion from nonselective NSAIDs to celecoxib can be useful for protecting patients with RA from small bowel injury.
authors: Department of Gastroenterology and Hepatology, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Takahiro
authors: T
authors: Inoue
authors: Hideki
authors: H
authors: Iijima
authors: Junsuke
authors: J
authors: Arimitsu
authors: Keisuke
authors: K
authors: Hagihara
authors: Shoichiro
authors: S
authors: Kawai
authors: Eri
authors: E
authors: Shiraishi
authors: Satoshi
authors: S
authors: Hiyama
authors: Akira
authors: A
authors: Mukai
authors: Shinichiro
authors: S
authors: Shinzaki
authors: Tsutomu
authors: T
authors: Nishida
authors: Atsushi
authors: A
authors: Ogata
authors: Masahiko
authors: M
authors: Tsujii
authors: Tetsuo
authors: T
authors: Takehara
mesh_terms: D000368:Aged; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000009:adverse effects* / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000188:drug therapy*; D053704:Capsule Endoscopy; D000068579:Celecoxib; D016207:Cytokines / Q000097:blood; D004008:Diclofenac / Q000009:adverse effects; D057915:Drug Substitution; D064420:Drug-Related Side Effects and Adverse Reactions / Q000517:prevention & control; D005260:Female; D006801:Humans; D007213:Indomethacin / Q000009:adverse effects; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology*; D007421:Intestine, Small / Q000187:drug effects / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D010666:Phenylpropionates / Q000009:adverse effects; D010865:Pilot Projects; D011446:Prospective Studies; D011720:Pyrazoles / Q000009:adverse effects* / Q000627:therapeutic use; D012720:Severity of Illness Index; D016037:Single-Blind Method; D013449:Sulfonamides / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D016207:Cytokines; D010666:Phenylpropionates; D011720:Pyrazoles; D013449:Sulfonamides; D004008:Diclofenac; C040656:loxoprofen; D000068579:Celecoxib; D007213:Indomethacin