Intolerable Symptoms Research Articles

Role of psychosocial factors on treatment outcome of temporomandibular disorders

Objectives: The aim of this randomized controlled study was to investigate the effect of depressive and non-specific physical symptoms on treatment outcome of temporomandibular disorders (TMD).Material and methods: Eighty TMD patients were randomly assigned to splint group (n = 39) and control group (n = 41). The patients were classified in terms of depressive and non-specific physical symptoms as normal, moderate or severe using Research Diagnostic Criteria for Temporomandibular Disorders Axis II protocol. The effect of depressive and non-specific physical symptoms on the intensity of facial pain, as measured with visual analogue scale (VAS) was estimated with linear mixed models. The patients’ subjective estimates of the effects of treatment and TMD symptom severity were inquired at 1-year follow-up.Results: At baseline and during the follow-up there were no significant differences in VAS scores between patients in different Axis II subscales. According to the mixed linear regression, depressiveness or nonspecific physical symptoms separately were not significantly associated with the VAS during the study. The association of VAS with depressive (p = .073) and nonspecific physical symptoms (p = .088) approximated statistical significance. Patients with moderate or severe nonspecific physical symptoms (with pain items) at baseline had more frequently moderate, severe or intolerable TMD symptoms after the treatment compared to those who were classified in normal subgroup.Conclusions: The present study gave some indication of a possible negative effect of depressive and nonspecific physical symptoms (with pain items) on TMD treatment response. However, the results should be regarded as preliminary, and further studies with larger sample size are needed to confirm the results.

What Is a Good Death?

What Is a Good Death?

Diagnostic value of the water deprivation test in the polyuria-polydipsia syndrome

Diabetes insipidus (DI) and primary polydipsia (PP) are characterised by polyuria and polydipsia. It is crucial to differentiate between these two disorders since the treatment is different. The aim of this study was to evaluate the diagnostic value of the short and an extended variant of the water deprivation test (WDT) and of measuring urinary vasopressin (AVP) in patients with polyuria and polydipsia. A retrospective, single-centre study based on WDTs performed between 2004 and 2014 including 104 consecutive patients with the polyuria-polydipsia syndrome. During a strict water deprivation, weight, urinary osmolality, urinary vasopressin and specific gravity were collected until one of the following was reached: i) >3% weight reduction, ii) Urinary specific gravity >1.020 or, urinary osmolality >800 mOsm/L, iii) Intolerable adverse symptoms such as excessive thirst. Out of 104 patients (67 women, 37 men), 21 (20%) were diagnosed with DI and 83 (80%) with PP. The median (interquartile range; range) test duration was 14 hours (10-16; 3-36) in patients with DI and 18 hours (14-24; 7-48) in patients with PP (P=0.011). Of those diagnosed with PP, 22 (26%) did not reach urinary specific gravity >1.020 nor urine osmolality >800 mOsm/L. Urine AVP did not overlap between patients with PP and patients with central DI. The short WDT is of limited value in the diagnostic work-up of polydipsia and polyuria and a partial DI may have been missed in every fourth patient diagnosed with PP. Urinary AVP has excellent potential in discriminating PP from central DI.

A Nationwide Survey About Palliative Sedation Involving Japanese Palliative Care Specialists: Intentions and Key Factors Used to Determine Sedation as Proportionally Appropriate

ContextAlthough there has long been debate about physicians' intentions and what physicians consider to be proportionally appropriate when performing palliative sedation, few large studies have been performed. ObjectivesTo identify physicians' intentions when starting continuous deep sedation and to clarify what factors determine whether physicians regard sedation as proportionally appropriate in relation to expected survival, the patients' wishes, and refractoriness. MethodsA nationwide questionnaire survey of Japanese palliative care specialists was performed from August to December 2016. We defined continuous deep sedation as the continuous use of sedatives to relieve intolerable and refractory symptoms with the loss of consciousness until death. ResultsOf the 695 palliative care specialists enrolled, 440 were analyzed (response rate, 69%). A total of 95% and 87% of the physicians reported that they explicitly intended to perform symptom palliation and decrease consciousness levels, respectively. Moreover, 38% answered that they explicitly intended to maintain unconsciousness until death, and 11% reported that they intended to shorten survival to some extent. The respondents considered that continuous deep sedation is more appropriate when the predicted survival is shorter, the patients' wishes are consistent and clear, and confidence in the refractoriness of symptoms is higher. ConclusionsJapanese palliative care specialists explicitly intend to control symptoms and reduce the level of consciousness when performing continuous deep sedation, but there are differences in their intentions with regard to maintaining unconsciousness until death. Predicted survival, patients' wishes, and confidence in refractoriness are associated with physicians' judgment that sedation is proportionally appropriate.

Safety and utility of dobutamine and pressure wire use in the hemodynamic assessment of low-flow, low-gradient aortic stenosis with reduced left ventricular ejection fraction.

The ACC/AHA guidelines recommend low-dose dobutamine challenge for hemodynamic assessment of the severity of AS in patients with low flow, low gradient aortic stenosis with reduced ejection fraction (EF) (LFLG-AS; stage D2). Inherent pitfalls of echocardiography could result in inaccurate aortic valve areas (AVA), which have downstream prognostic implications. Data on the safety and efficacy of coronary pressure wire and fluid-filled catheter use for low dose dobutamine infusion is sparse. We retrospectively analyzed 39 consecutive patients with EF<50%, AVA<1cm2 and SVI<35ml/m2 on echocardiography who underwent simultaneous right and left heart catheterization. Hemodynamic assessments were performed at baseline and at every increment in the dobutamine infusion rate (The infusion was continued until maximal dose of dobutamine or a mean AV gradient>40mmHg was attained. The occurrence of sustained ventricular arrhythmias, symptomatic hypotension or intolerable symptoms leading to cessation of infusion was recorded. Transient ischemic attacks (TIAs) or clinically apparent strokes periprocedurally or up to 30days after the procedure were recorded. Dobutamine challenge confirmed true AS in 26 patients (67%) and pseudosevere AS in 34%. No sustained arrhythmias, hypotension or cessation of infusion from intolerable symptoms were observed. No clinical strokes or TIAs were observed up to 30days after procedure in any of these patients. Hemodynamic assessment of AS using a pressure wire with dobutamine challenge is a safe and effective tool in identifying truly severe AS in patients with LFLG-AS with reduced EF.

A Systematic Review Investigating the Impact of Modified Varenicline Regimens on Smoking Cessation

Introduction: The efficacy of varenicline as a smoking cessation aid is affected by commonly-occurring issues, such as intolerable adverse events, cravings and withdrawal symptoms, and poor medication adherence. Improvement in quit rates may be achieved through tailoring doses relative to individual smokers’ behaviours, and previous experiences with smoking cessation medications.Aims: The aim of this review is to evaluate smoking cessation outcomes from published randomised controlled trials that have attempted to improve the efficacy and tolerability of varenicline through modifying its dosage regimen compared to placebo.Methods: A systematic search of the literature up to June 2016 was conducted to identify randomised controlled trials, where varenicline was administered in a regimen not consistent with the current clinical guidelines. Outcome measures evaluated included continuous abstinence rates, changes in cravings, withdrawal symptoms, smoking behaviours, adverse event rates, and premature therapy discontinuations.Results: Ten randomised controlled trials, encompassing four different modifications to standard varenicline therapy, matched the eligibility criteria. Modifications such as the extended duration of therapy and the use of a flexible quit date were effective compared to placebo and have been implemented into some clinical guidelines, whereas other modifications do not appear to produce any benefit for smokers, or require further research to ascertain their suitability for clinical practice.Conclusions: Some varenicline therapy modifications may lead to improvements in efficacy and tolerability. Further research on the effect of modifications such as daily doses higher than 2mg, tapering doses, and the use of extended pre-quit varenicline may advance varenicline therapy outcomes.

"I Would Go if My Arm Were Hanging off": A Qualitative Study of Healthcare-Seeking Behaviors of Small Farm Owners in Central New York State.

Compared to their rural non-farming peers, farmers are less likely to access preventive healthcare services; however, the reasons for this disparity are poorly understood. We conducted semi-structured interviews with a total of 30 farm household members in central New York. Interview topics included farming identity, perceptions of one's health, past experiences with acute and preventive healthcare, and attitudes toward seeking healthcare services. Grounded Theory analysis of the interview transcripts revealed that (1) utilizing healthcare services is felt to be in conflict with the farming identity, (2) the need to conserve time and money for farm applications poses a barrier to healthcare utilization, (3) farmers decide to seek healthcare when they believe it is necessary to ensure survival of the farm, and (4) the decision to seek healthcare is most strongly driven by the presence of intolerable symptoms, prompting from others, and the perception that treatment will yield clear benefits. Efforts to increase farmers' utilization of healthcare services must address these considerations.

Long-term hormone therapy for perimenopausal and postmenopausal women.

Long-term hormone therapy for perimenopausal and postmenopausal women.

Chapter 9 - Epidemiology, clinical presentation, diagnostic evaluation, and prognosis of cerebral dural arteriovenous fistulas

Dural arteriovenous fistulas are abnormal communications, within the dural leaflets, between meningeal arteries and dural venous sinuses and/or subarachnoid veins. Although many fistulas remain clinically silent and do not require treatment, presence of cortical venous reflux, intracranial bleed, and intolerable symptoms are the main indications for treatment. A thorough understanding of the natural history is of prime importance in the decision making and management of these lesions. In this chapter we discuss the epidemiology and natural history of intracranial dural arteriovenous fistulae.

An Alternative Narrative.

An Alternative Narrative.

Surgical Management of Functional Constipation: Preliminary Report of a New Approach Using a Laparoscopic Sigmoid Resection Combined with a Malone Appendicostomy.

Introduction Functional constipation is a common problem in children. It usually can be managed with laxatives but a small subset of patients develop intolerable cramps and need to be temporarily treated with enemas. The senior author has previously reported: 1) open sigmoid resection as a surgical option, but this did not sufficiently reduce the laxative need, then 2) a transanal approach (with resection of rectosigmoid), but this led to a high rate of soiling due to extensive stretching of the anal canal and loss of the rectal reservoir. The understanding of these procedures' results has led us to use a laparoscopic sigmoid ± left colonic resection with a Malone appendicostomy for these patients, to decrease the laxative requirements, temporarily treat with antegrade flushes, and to reduce postoperative soiling. Methods A single-institution retrospective review (3/2014-9/2015) included patients who failed our laxative protocol, and therefore were considered surgical candidates. Patients with anorectal malformation (ARM), Hirschsprung disease, spina bifida, tethered cord, trisomy 21, cerebral palsy, mitochondrial disease, prior colon resection at other facilities, or those that did not participate in our laxative program were excluded. Demographics, duration of symptoms, prior treatments, postoperative complications, and postoperative bowel regimens were evaluated. Results A total of 6 patients (3 males; median age of 12.5 years) presented with soiling related to constipation and intolerance to laxatives. Four patients failed preoperative cecostomy (done prior to referral to us). An average of 4.7 medication treatments were previously tried. In all, 4 patients had required in-patient disimpactions. Duration of symptoms was 7.5 years (median). The median senna dose was 30 mg (range, 15-150 mg), and all patients had intolerable symptoms or failed to empty their colon, which we considered a failed laxative trial. All had contrast enemas that demonstrated a dilated and/or redundant sigmoid colon, and colonic manometry was abnormal in 4. All patients underwent laparoscopic sigmoid and left colon resection, or only sigmoid resection (a low anterior resection). Two patients had postoperative colitis treated with oral antibiotics. The median follow-up was 52 days (range, 8-304 days). Five patients are on antegrade enemas with plans to convert to laxatives at 6 months, 1 is taking laxatives alone at a 33% lower dosage. Five of six are completely clean, 1 soils occasionally and their daily flush is being adjusted. Conclusion Only a minority of patients with functional constipation are medically unmanageable. This preliminary report shows that laparoscopic colon resection combined with antegrade flushes is an effective surgical technique to treat that group. A laparoscopic approach, guided by contrast enema and colonic manometry, allows for a defined resection of the abnormal segment of colon with the advantages of minimally invasive surgery including allowing for an extensive rectal resection (an improvement over open sigmoid resection) and avoidance of overstretching of the anal canal and removal of the rectal reservoir (an improvement over the transanal approach). Having antegrade access is useful to manage soiling and avoiding cramping from laxatives in the early postoperative period. Although our series is small, we believe that long-term most patients can avoid antegrade flushes and be on no, or a dramatically reduced, laxative dose.

The efficacy and safety of ureteral stenting after transurethral resection (TUR) of bladder tumors involving the ureteral orifice

Objective To evaluate the efficacy and safety of ureteral stenting after transurethral resection (TUR) of bladder tumors involving the ureteral orifice. Methods From March 2009 to November 2015, 34 cases of non-muscle invasive bladder tumor including 28 male and 6 female aged from 26 to 79 years(mean 51 years) were treated by TUR. 14 cases had single tumor and 20 had multiple tumors, and 29 were primary and 5 were recurrent. All the patients had tumors involving the ureteral orifice without preoperative hydronephrosis revealed by IVU or CTU examination. The tumors were resected into the deep muscle layer and the involved ureteral orifices were resected during the procedure, and after that a double-J ureteral stent was placed in 18 cases. All patients received one immediate intravesical instillation of 50mg epirubicin after TUR, and further scheme of adjuvant intravesical chemotherapy instillations were made according to the pathological diagnosis. Ureteral stents were removed 10-12 weeks after TUR, and cystoscopy and urinary tract ultrasound examinations were performed every 3 months for 1-2 years postoperatively. Results The operations were successful without complications. No serious adverse reaction occurred in immediate and further adjuvant intravesical chemotherapy. During the follow-up period of 3-71 months, no ureteral stricture, hydronephrosis or tumor recurrence in the upper urinary tract occurred in all the 18 patients with ureteral stent, and the resected ureteral orifices recovered well with normal appearance and ejecting urine. Hydronephrosis was observed in 3 of 16 patients without ureteral stent including 2 cases of nontumoral stenosis at the ureterovesical junction requiring ureteral reimplantation and 1 case of lower ureteral tumor on the involved side requiring nephroureterectomy and bladder cuff excision. No patient complained of symptoms secondary to vesicoureteral reflux or continuous unrelievable lower urinary tract symptoms. 2 cases of bladder tumor recurred out of the resected area. Conclusions Ureteral stenting after TUR of bladder tumors involving the ureteral orifice can prevent stricture at the ureterovesical junction without increasing the risk of tumor cell seeding along the upper urinary tract. The existence of a double-J ureteral stent does not increase complications of adjuvant intravesical chemotherapy, and also won't cause intolerable lower urinary tract symptoms. Key words: Urinary bladder neoplasms; Transitional cell carcinoma; Transurethral resection; Hydronephrosis; Neoplasm recurrence

Combination leflunomide and methotrexate in refractory rheumatoid arthritis: a biologic sparing approach.

In resource-constrained settings where biologic agents are not widely available, there are limited therapeutic options for patients with rheumatoid arthritis (RA) refractory to other synthetic disease modifying antirheumatic (DMARD) therapies. The aim of this study is to evaluate the effectiveness and safety of leflunomide (LEF) with methotrexate (MTX) in refractory RA. A retrospective record review of adult RA patients treated with LEF/MTX. Demographic details, adverse reactions, and the 3-variable 28 joint disease activity score (DAS28-3) were recorded at initiation of LEF/MTX therapy, and after 4 and 12 months of treatment. Of 194 patients, most were middle-aged seropositive Black African females, with established disease [mean (standard deviation, SD) disease duration 9.4 (8.2) years] and time on previous DMARDs of 7.0 (5.5) years. Before adding LEF, the mean (SD) dose of MTX was 21.7 (3.5) mg/week, and 87.6% of patients used low dose oral corticosteroids. A good or moderate EULAR response was achieved by 44% and 42% of patients, and the retention rate was 71%. Major infections were seen in 6 patients: comprising 2 deaths, 3 cases of leucopaenia and septicaemia and 1 case of tuberculosis. Hepatotoxicity (n = 3), intolerable gastrointestinal symptoms (n = 3), and hypertension (n = 17) were the most common problems. Predictors of remission or low disease activity at 12 months was a baseline DAS28-3 ⩽ 5.5 [odds ratio (OR) = 2.7; 95% confidence interval (CI) 1.1-5.6; p = 0.01]. LEF/MTX was effective in the majority of patients in this cohort of mainly Black African women who failed other combination synthetic DMARDs, particularly in those with moderate disease activity at the time of addition of LEF. Infections and hypertension were important complications. In a setting where biologic DMARDs are not readily accessible, the combination of LEF/MTX is a cost-effective approach.

Hemodynamic profile and heart rate variability in hyperadrenergic versus non-hyperadrenergic postural orthostatic tachycardia syndrome

ObjectivesTo investigate differences in hemodynamic profile between hyperadrenergic and non-hyperadrenergic postural orthostatic tachycardia syndrome (POTS) in response to head-up tilt test (HUTT). MethodsTen patients with hyperadrenergic and 33 patients with non-hyperadrenergic POTS underwent HUTT consisting of a 10-min supine phase and 30-min 70° tilted phase. Heart rate (HR), systolic and diastolic blood pressure (dBP), and heart rate variability (HRV) parameters of the two groups were compared. ResultsHyperadrenergic patients had higher supine HR (82.6±16.3bpm vs. 73.8±10.4bpm, p=0.048). Supine HRV analysis showed significantly lower cardiac vagal activity and possible predominance of cardiac sympathetic activity in the hyperadrenergic group. Non-hyperadrenergic patients had lower dBP during the first four minutes of tilt. Furthermore, 60% of non-hyperadrenergic patients had lower average dBP in the 1st minute of tilted phase when compared to supine values, whereas only 2 of 10 hyperadrenergic patients exhibited the same response. Syncope or intolerable symptoms, causing early ending of HUTT, developed earlier in the non-hyperadrenergic group (8.9±6.8min vs. 21.2±3.5min, p=0.001). ConclusionHyperadrenergic and non-hyperadrenergic type of POTS seem to have distinctly different response to HUTT. SignificanceThis study has shown significant differences in hemodynamic response to HUTT between hyperadrenergic and non-hyperadrenergic type of POTS indicating possible differences in their pathophysiology.

The Use of Palliative Sedation for Terminally Ill Patients: Review of the Literature and an Argumentative Essay

Palliative sedation for terminally ill patients, with a life expectancy of less than two weeks to control patients’ intolerable pain and symptoms, is an intervention that raises many legal and ethical controversial issues. The purpose of this paper is to write an argumentative essay to support the use of palliative sedation for terminally ill patients, taking into consideration the legal and ethical points of view of opponents and proponents. Although it is illegal in some countries such as France, Jordan and New-Zealand, palliative sedation for terminally ill patients is legally sound for other countries such as USA, Canada, Sweden, Belgium, and Netherlands. Ethically, opponents consider palliative sedation for terminally ill patients as a misleading concept as it hastens death and negatively influences patients’ family members, and it may be misused by health team members. Whereas, proponents debate that palliative sedation is a multidisciplinary intervention that should be considered as a last resort for terminally ill patients with the main intention of relieving patients’ agony and having no effect on patients’ survival; moreover, it positively influences patients’ family members. The author is encouraged to support the use of palliative sedation as it is a multidisciplinary judgement which guarantees that any decision made is built on the latest evidence-based guidelines and is ethically accepted according to the principles of beneficence, autonomy, and doctrine of double effect. Additionally, it is the last and only intervention to alleviate patients’ suffering without affecting patients’ survival, thus causing family members to accept the use of palliative sedation for their loved ones.

Laparoscopic sleeve gastrectomy in obese Korean patients: up to 4-year follow-up in a single center.

PurposeLaparoscopic sleeve gastrectomy (LSG) has been gaining marked popularity as a stand-alone treatment for morbid obesity. This study aimed to evaluate the midterm outcomes and efficacy of LSG performed at a single center in Korea.MethodsThe records of 192 consecutive patients who underwent LSG between April 2009 and December 2012 were retrospectively reviewed. The patients' demographics and surgical outcomes including anthropometric data were analyzed.ResultsThe mean preoperative body mass index was 40.0 ± 7.2 kg/m2, and 120 patients (62.5%) had at least one obesity-related comorbidity. Three patients (1.6%) required endoscopic or surgical intervention to manage postoperative bleeding or leakage. At the postoperative 1-, 2-, 3-, and 4-year follow-ups, the mean percent of excess weight loss (%EWL) values were 72.6%, 80.6%, 71.1%, and 57.8%, respectively, with follow-up rates of 81%, 56%, 58%, and 30% respectively. The overall mean %EWL reached 68.3% ± 27.2% at a mean follow-up of 25 months. Obesity-related comorbidities were resolved in >70% of the patients after surgery. Twelve months after LSG, 25 patients (13.0%) showed a %EWL of <50%; 9 (4.7%) required conversion to gastric bypass due to inadequate weight loss, intolerable reflux symptoms, or intractable diabetes.ConclusionThese midterm results show that LSG is a safe and effective surgical procedure for morbidly obese patients. However, a longer follow-up period is necessary to elucidate whether LSG can achieve durable weight loss and long-term outcomes, comparable to those of more aggressive procedures.

ESMO Clinical Practice Guidelines for the management of refractory symptoms at the end of life and the use of palliative sedation

In patients with advanced cancer, a readiness to address pain and other intolerable symptoms is a medical and moral imperative [1]. This has been described by Roy as the ‘emancipation principle of palliative care’ which states: ‘(one should) spare no scientific or clinical effort to free dying persons from twisting and racking pain that invades, dominates, and shrivels their consciousness, that leaves them no psychic or mental space for the things they want to think and say, and do before they die.’ [2]. Indeed, there is a broad ethical consensus that, at the end of life, the provision of adequate relief of symptoms is an overriding goal, which must be pursued even in the setting of a narrow therapeutic index for the necessary palliative treatments [1, 3–12]. The provision of adequate relief of physical symptoms such as pain is a central aspect of medical care of all patients. In the care of patients with incurable illnesses that generate intense and prolonged patient suffering, this aspect of care assumes a critical significance.

Larynx during exercise: the unexplored bottleneck of the airways.

Exercise-induced shortness of breath is not uncommon in otherwise healthy young people. Based on the presenting symptoms alone, it is challenging to distinguish exercise-induced asthma (EIA) from exercise-induced obstruction of central airways, sometimes leading to diagnostic errors and inadequate treatment. Central airway obstruction usually presents with exercise-induced inspiratory symptoms (EIIS) during ongoing exercise. EIIS tends to peak towards the end of an exercise session or immediately after its completion, contradicting symptoms of EIA typically peaking 3–15 min after the exercise has stopped. EIIS is usually associated with some form of laryngeal obstruction. Transnasal flexible laryngoscopy performed continuously throughout an incremental exercise test from rest to exhaustion or to intolerable symptoms is usually diagnostic, and also provides information that is important for further handling and treatment. Reflecting the complex anatomy and functional features of the larynx, exercise-induced laryngeal obstruction (EILO) appears to be a heterogeneous condition. Contradicting previous beliefs, recent literature suggests that laryngeal adduction in a majority of cases starts in supraglottic structures and that vocal cord adduction (VCD) most often occurs as a secondary phenomenon. However, EILO is poorly understood and more and better research is needed to unravel causal mechanisms. The evidence base for treatment of EILO is weak. Speech therapy, psychotherapy, biofeedback, muscle training, anticholinergic aerosols have all been applied, as has laser supraglottoplasty. Randomized controlled trials with well-defined and verifiable inclusion and success criteria are required to establish evidence-based treatment schemes.Electronic supplementary materialThe online version of this article (doi:10.1007/s00405-014-3159-3) contains supplementary material, which is available to authorized users.

AB0456 Combination Leflunomide and Methotreaxate in Refractory RA: A Biologic-Sparing Approach

BackgroundIn resource-constrained settings where biologic agents are not widely available, there are limited therapeutic option for patients with rheumatoid arthritis (RA) refractory to triple disease modifying antirheumatic (DMARD) combination therapyObjectivesTo...

The efficacy of rebamipide add-on therapy in arthritic patients with COX-2 selective inhibitor-related gastrointestinal events: a prospective, randomized, open-label blinded-endpoint pilot study by the GLORIA study group

Objective We aimed to confirm the effect of combined treatment with celecoxib and rebamipide would be more effective than celecoxib alone for prevention of upper gastrointestinal (GI) events.Methods Patients with rheumatoid arthritis, osteoarthritis, and low back pain were enrolled in this study. Patients were randomized to two groups: a monotherapy group (100 mg celecoxib twice daily) and a combination therapy group (add on100 mg of rebamipide three times a day). The GI mucosal injury was evaluated by endoscopic examination before treatment and at 3 months. The primary endpoint was to evaluate the preventive effect of the combination therapy group for GI events, endoscopic upper GI ulcers and intolerable GI symptoms, compared with the monotherapy group.Results Seventy-five patients were enrolled. Sixty-five patients were analyzed (16 males, 49 females; mean age: 67 ± 13 years). The prevalence of upper GI events, five of endoscopic GI ulcers and one of intolerable GI symptoms, were 6/34 (17.6 %) in the monotherapy group and 0/31 in the combination therapy group, p = 0.0252.Conclusions The combination therapy group was more effective than the monotherapy group for prevention of upper GI events in this study. Rebamipide might be a candidate for an option to prevent COX-2 selective inhibitor-induced upper GI events.