MEDICAL HYPOTHESES AND RESEARCH
VOL. 2, No. 2, January 2005
F. T. Shaya, et al.  Med Hypotheses Res 2: 401-411.
Nonselective Cyclooxygenase Inhibition and
Gastrointestinal Effects: A Review of Recent Clinical
Fadia T. Shaya*, Navendu Samant and Jung Kim
Center on Drugs and Public Policy, University of Maryland School of Pharmacy, Baltimore,
Maryland 21201, USA
Abstract. Introduction. Nonsteroidal anti-inflammatory drugs (NSAIDs) are
medications which, besides having pain-relieving (analgesic) effects, have the effect of
reducing inflammation. NSAIDs have been associated with adverse gastrointestinal (GI)
events such as dyspepsia and upper abdominal pain. Objective. The goal of the review is to
provide an updated document assessing the risk of GI complications induced by the most
commonly used non-selective NSAIDs by reporting comparative evidence of gastrointestinal
toxicity between traditional NSAIDs and cyclooxygenase-2 (COX-2) inhibitors. Methods. A
total of 12 published studies were reviewed and compared on the basis of trial design,
inclusion and exclusion factors, treatment regimens, clinical endpoints, outcomes, and date
of publication. Results. The clinical endpoints of primary focus were gastric or duodenal
perforation, gastric outlet obstruction, upper GI bleeding, and gastric or duodenal ulcers.
The studies under review showed that in patients with increased susceptibility to
gastrointestinal adverse events, a lower risk of upper gastrointestinal bleeding was observed
in users of COX-2 inhibitors compared with users of NSAIDs. Conclusion. Studies indicated
that COX-2 inhibitors were used more frequently than were traditional NSAIDs in certain
groups of patients with varying cardiac or gastrointestinal risk. As further discussions evolve
about the safety of COX-2 inhibitors, the same questions will be asked about their
alternatives, including NSAIDs and other drugs. In that respect, the management of the GI
effects is important.
*Address all correspondence to: Dr. Fadia T. Shaya, Center on Drugs and Public Policy,
University of Maryland School of Pharmacy, 515 West Lombard Street, 2nd Floor,
Baltimore, Maryland 21201, USA. Phone: 410-706-5392. Fax: 410-706-5394.
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