| セッション情報 |
International Forum 1(Gastrointestinal tract) 4.Prevention of NSAIDs-gastropathy
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| タイトル |
IF1-4-III (Plenary presentation) Effect of COX-2 inhibition on the integrity of gastric ulcer scar-a double-blindrandomized trial
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| 演者 |
Vincent W.S.Wong（Department of Medicine and Therapeutics and Institute of Digestive DiseaseThe Chinese University of Hong KongShatinHong Kong） |
| 共同演者 |
Jessica Y.L.Ching（Department of Medicine and Therapeutics and Institute of Digestive DiseaseThe Chinese University of Hong KongShatinHong Kong）, B.Y.Suen（Department of Medicine and Therapeutics and Institute of Digestive DiseaseThe Chinese University of Hong KongShatinHong Kong）, P.K.Ma（Department of Medicine and Therapeutics and Institute of Digestive DiseaseThe Chinese University of Hong KongShatinHong Kong）, Francis K.L.Chan（Department of Medicine and Therapeutics and Institute of Digestive DiseaseThe Chinese University of Hong KongShatinHong Kong） |
| 抄録 |
Background ： We previously showed that up to 20% of patients on celecoxiba cyclooxygenase （COX）-2inhibitorhad ulcer recurrence after an episode of peptic ulcer bleeding． Most ulcers recurred at the origi-nal ulcer site． We hypothesized that COX-2 contributes to maintaining the integrity of ulcer scar．Methods ： We conducted a double-blindrandomizedparallel-group trial Patients who presented withNSAID-induced gastric ulcer bleeding were eligible if they had visible healed ulcer scars on follow-up en-doscopy and a histological test for Helihacter pylori was negative． Eligible patients were randomly as-signed to receive celecoxib 200 mg twice daily or paracetamol 1 g twice daily as identical-appearing studydrugs for 4 weeks． The primary endpoint was ulcer recurrence． Other endpoints include COX-2 expres-sion and prostaglandin E2 synthesis at the ulcer scar．Results ： Sixteen patients were randomly assigned to receive celecoxib or paracetamol （8 in each group） ．Ulcer recurrence occurred in seven patients in the celecoxib group （88%） and one patient in the paraceta-mol group （13%p＝O．Ol）all at the original ulcer site． COX-2 expression was upregulated at the ulcerscars but not at the adj acent normal antral tissue． Prostaglandin E2 synthesis was not increased at the re-current ulcers in the celecoxib group．Conclusion ： Celecoxib use in patients with history of gastric ulcer bleeding is associated with a high ul-cer recurrence rate at the original ulcer site． This is probably due to COX-2 overexpression at the ulcerscarinhibition of which would affect the inte grity of the scar． |
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