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Coxibs and NSAIDs with gastroprotective agents offer better protection from ulcers than NSAIDs alone

Some patients who regularly take nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief risk developing peptic ulcers because of those drugs. For high-risk patients, the side effects of these drugs can be offset if an alternate pain reliever or an additional drug that protects the stomach is prescribed.

To find out which drugs or drug combinations best prevent ulcers among NSAID users, Wayne A. Ray, Ph.D., of the Vanderbilt University School of Medicine studied 9 years' worth of Medicaid records in Tennessee. This study of nearly 300,000 records examined NSAID use—alone and with gastroprotective drugs—and coxibs, which relieve pain but also lower the risk of ulcers.

Patients who took NSAIDs with no gastroprotective drugs were hospitalized with peptic ulcers nearly three times more often than patients not using NSAIDs or coxibs. This hospitalization risk was reduced 39 percent for patients who took gastroprotective drugs with their NSAIDs and 40 percent for those who took coxibs alone.

The researchers suggest that, of the gastroprotective drugs available, proton pump inhibitors offer the most benefit for both NSAID and coxib users. These drugs reduce the production of acid in the stomach to prevent ulcers from forming and let existing ulcers heal. The best protection from ulcers came from using a coxib and a proton pump inhibitor.

The researchers also found that patients who took naproxen, but had no gastroprotective therapy, were at the highest risk for being hospitalized with an ulcer. When naproxen and proton pumps were used together, however, this risk was cut in half. Of all the NSAIDs studied, ibuprofen was the least likely to cause ulcers. This study was funded in part by the Agency for Healthcare Research and Quality (HS10384).

See "Risk of peptic ulcer hospitalizations in users of NSAIDs with gastroprotective cotherapy versus coxibs," by Dr. Ray, Cecilia P. Chung, M.D., Ph.D., C. Michael Stein, M.D., and others in the September 2007 Gastroenterology 133(3), pp. 790-798.

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