PPIs May Up Risk of NSAID-Induced Small Bowel Injury

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Increased risk with celecoxib
Increased risk with celecoxib

(HealthDay News) — Proton pump inhibitors (PPIs) increase the risk of nonsteroidal anti-inflammatory drug-induced small bowel injury, according to a study published in the June issue of Clinical Gastroenterology and Hepatology.

Ema Washio, from Kyushu University in Fukuoka, Japan, and colleagues randomized healthy participants to receive the cyclooxygenase (COX)-2 inhibitor celecoxib plus placebo for two weeks (30 participants) or celecoxib plus the PPI rabeprazole for two weeks (27 participants). Participants were assessed by capsule endoscopy at the start of the study and two weeks after celecoxib administration.

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The researchers found that the proportion of participants who developed small bowel injury was higher in the COX-2 + PPI group than the COX-2 + placebo group (44.4 versus 16.7 percent, respectively; P = 0.04). The risk of small bowel injury was increased for individuals in the COX-2 + PPI group versus the COX-2 + placebo group (relative risk, 2.67). Each member of the COX-2 + PPI group had a greater number of erosions than each member of the COX-2 + placebo group (P = 0.02). There was no between-group difference in the number of ulcers. Mucosal injury in the jejunum occurred in 26 percent of the COX-2 + PPI group compared with none of the COX-2 + placebo group (P = 0.003).

"In a randomized, controlled trial, PPIs increased the risk of short-term nonsteroidal anti-inflammatory drug-induced small bowel injury," the authors write.

The study was funded by Eisai.

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