Gastrointestinal affectation by NSAID has three manifestations: dyspepsia, ulcers and haemorrhages. Coxib type NSAIDs that only inhibit COX-2 have a lower complication rate on a gastrointestinal level. The results of a review of the studies published to date lead to the conclusion that Celecoxib has a significantly less number of serious gastrointestinal complications (haemorrhage and perforation) than conventional NSAIDs, and in addition, it also has a lower frequency of non-serious complications such as dyspepsia and intestinal disorders. The question now being posed is: when should gastroprotection be considered? Current guidelines suggest defining those patients considered of risk age > 65 years, background of ulcer or serious gastrointestinal complications, treatments with steroids or anticoagulants, other associated serious diseases and prolonged treatments. The eradication of Helicobacter Pylori is currently considered a treatment of choice, irrespective of the use of any type of NSAID and proton pump inhibitor. Finally adopting the best option for a certain patient results in the use of Celecoxib over NSAID + PPI in patients with risk presenting: less lesions in the lower digestive tract; better compliance with the treatment; better tolerance; and under normal conditions it is not more expensive. The recommendations of the Spanish Agency of Gastroenterology and the Spanish Gastroenterology Society suggest: The use of Celecoxib is as safe as the combination of NSAID + PPI. The overall frequency of complications of the upper and lower digestive tract is favourable to Celecoxib. Patients under treatment with low doses of aspirin should receive associated treatment with PPI.
|Publication status||Published - 1 Dec 2005|
- Gastrointestinal tolerance