Arthritis and Stomach Ulcers?
Study Finds Celebrex No Safer Than NSAIDs in Preventing Recurring Bleeding
This finding is significant because one in four patients who routinely take NSAIDs for arthritis relief develop some signs of these stomach, or peptic, ulcers. Each year, about 4% of these patients develop full-blown bleeding ulcers. "Once you have an ulcer that bleeds, they are extremely difficult to heal and recur almost the day you start taking NSAIDS again," says Graham.
Besides NSAID use, the other primary cause of peptic ulcers is infection by Helicobacter pylori (H. pylori), a bacterium that afflicts about one in five Americans younger than age 40 and as many as half of those older than 60. Both NSAIDs and H. pylori weaken the protective mucous coating of the stomach and duodenum, the upper portion of the intestines, allowing acid to eat into this lining, causing an ulcer.
Because of the high rate of peptic ulcers associated with NSAID use, arthritis patients were often left with a dilemma: Manage the arthritis pain and risk serious stomach complications or manage the ulcer and live with the pain. Then along came Celebrex -- and months later, Vioxx, which promised freedom from both problems.
But the new study found that "rates of recurrent ulcer bleeding were substantial" in both the 144 participants who took Celebrex and the 143 who received diclofenac (sold as Voltaren or Cataflam) plus Prilosec, which previous studies indicate helps protect against these ulcers. All 287 study participants had tested negative for H. pylori infection.
"The prediction has been that COX-2 inhibitors would not be associated with this recurrence," Graham tells WebMD. "But now, it's clear that we need to do more to find out what we can do for these high-risk patients. The question is, what?"