Nonsteroidal anti-inflammatory drugs versus selective COX-2 inhibitors in the upper gastrointestinal tract

There are enough basic data supporting the use of coxibs with regard to the upper GI tract in patients with the need for continuous treatment of joint pain. The clinical studies available clearly show that coxibs induce fewer lesions and complications in volunteers and in patients when compared with NSAIDs. However, in Helicobacter pylori- positive patients the advantage seems less clear. The combination of NSAID plus PPI is not worse with regard to duodenal ulcers and recurrent clinical complications and is more cost effective than the use of coxibs. Similarly, with the concomitant use of aspirin even in low doses no major advantage of coxibs has been demonstrated. The combination of coxibs and PPI in high-risk patients needs to be studied. It is unclear at the moment how important are the changes in the lower GI tract. Considering the current controversy regarding cardiovascular events, there is no major reason to prefer coxibs to conventional NSAID plus PPI in patients needing long-term treatment.