As many as 25% of chronic NSAID users will develop ulcer diseaseA major disadvantage of NSAID use is the gastrointestinal side effects. These range from abdominal pain, nausea, diarrhea, and dyspepsia to more serious events, such as gastric or duodenal ulcers, anemia, and bleeding, or perforated ulcer. These side effects are due to the simultaneous inhibition of COX-1 and COX-2.
2%–4% will bleed or perforate, especially those who have been designated as being in a high-risk category
The overall risk for these complications in patients taking NSAIDs was approximately 2.4.
(2) with substitution of a traditional NSAID by a COX-2 inhibitor
The article on ulcer formation in COX-2 (Celebrex) vs NSAIDS:
Goldstein et al14 determined gastroduodenal damage
from endoscopy after 4, 8, and 12 weeks of treatment with celecoxib 200 mg twice daily or naproxen 500 mg twice daily in 537 patients with osteoarthritis or rheumatoid arthritis.The cumulative incidence of gastric and duodenal ulceration for celecoxib was 9% and for naproxen was 41%. In the group that received celecoxib, the occurrence of ulcers was significantly associated with a number of factors, including H. pylori positivity, concurrent aspirin usage, and a history of ulcers.
Combination therapy versus celecoxib, a single selective COX-2 agent, to reduce gastrointestinal toxicity in arthritic patients: patient and cost-effectiveness considerations; Marina Scolnik, Gurkirpal Singh; Open Access Rheumatology: Research and Reviews 2011:3 53–62