Abstract
Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with risk for gastrointestinal bleeding. Risk for gastroduodenal ulceration and bleeding can be lowered by substituting cyclooxygenase (COX)-2–selective NSAIDs for nonselective NSAIDs or by treating patients simultaneously with nonselective NSAIDs and proton-pump inhibitors (PPIs). A substantial number of bleeding episodes, however, occur distal to the duodenum. The mechanism for this effect, and the optimal therapeutic approach to alleviate it, is unclear. Even COX-2–selective NSAIDs are associated with more small-bowel lesions than is placebo (Journal Watch Gastroenterology Jul 20 2007). To evaluate the prevalence of small-bowel lesions in patients who took conventional or COX-2–selective NSAIDs, …
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