Small bowel injury induced by selective cyclooxygenase-2 inhibitors : a prospective, double-blind, randomized clinical trial comparing celecoxib and meloxicam

• Published in: Journal of gastroenterology Vol. 47; no. 4; pp. 387 - 393
• Main Authors: Maehata, Yuji, Esaki, Motohiro, Morishita, Toshibumi, Kochi, Shuji, Endo, Shingo, Shikata, Kentaro, Kobayashi, Hiroyuki, Matsumoto, Takayuki
• Format: Journal Article
• Language: English
• Published: Japan Springer Japan 01.04.2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adult; Capsule Endoscopes; Capsule endoscopy; Celecoxib; Clinical trials; Colorectal Surgery; Comparative analysis; COX-2 inhibitors; Cyclooxygenase 2 Inhibitors - adverse effects; Cyclooxygenase 2 Inhibitors - therapeutic use; Double-Blind Method; Duodenal Ulcer - chemically induced; Endoscopy; Female; Gastroenterology; Hepatology; Humans; Intestinal Mucosa - drug effects; Intestinal Mucosa - pathology; Intestine, Small - drug effects; Intestine, Small - pathology; Male; Medicine; Medicine & Public Health; Meloxicam; Middle Aged; Original Article—Alimentary Tract; Prospective Studies; Pyrazoles - adverse effects; Pyrazoles - therapeutic use; Selective cyclooxygenase-2 inhibitor; Small bowel mucosal injury; Sulfonamides - adverse effects; Sulfonamides - therapeutic use; Surgical Oncology; Thiazines - adverse effects; Thiazines - therapeutic use; Thiazoles - adverse effects; Thiazoles - therapeutic use; Young Adult; Small bowel mucosal injury; Capsule endoscopy; Selective cyclooxygenase-2 inhibitor
• ISSN: 0944-1174; 1435-5922; 1435-5922
• DOI: 10.1007/s00535-011-0501-z

Background Selective cyclooxygenase (COX)-2 inhibitors are less harmful to the small bowel mucosa than non-selective anti-inflammatory drugs. We aimed to compare the severity of small bowel mucosal injury in healthy volunteers induced by two selective COX-2 inhibitors, celecoxib and meloxicam, in a randomized, double-blind trial, using capsule endoscopy (CE). Methods Twenty-nine healthy subjects were randomized to take either celecoxib (200 mg twice daily) or meloxicam (10 mg once daily) for 2 weeks. The incidence and the number of small bowel mucosal injuries (bleeding, ulcers, and erosions) observed by CE were compared between the two groups. Results The overall incidence of small bowel mucosal injury was not different between the celecoxib group (6 of 14 subjects, 42.9%) and the meloxicam group (4 of 15 subjects, 26.7%, P  = 0.45). In subjects with positive CE findings, the number of ulcers was greater in the meloxicam group than in the celecoxib group ( P  = 0.02), while such a trend was not found with regard to erosions ( P  = 0.52). The distribution of mucosal lesions within the small bowel was similar in the two groups. Conclusions Selective COX-2 inhibitors are not completely safe for the small bowel. The mucosal lesions may be less severe with celecoxib than with meloxicam.