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Nonsteroidal anti-inflammatory drugs (NSAIDs) are associated with increased risks for upper and lower gastrointestinal bleeding. The risk for upper GI bleeding can be reduced by using a cyclooxygenase (COX)-2–selective NSAID, a proton-pump inhibitor (PPI), or misoprostol. However, the mechanisms responsible for lower GI bleeding differ from those responsible for upper GI events, and we do not yet know whether the same interventions will reduce both types of events. A prior post hoc analysis of a large study suggested that patients taking rofecoxib had fewer lower GI events than did those taking naproxen (JW Gastroenterol Mar 11 2003).
To address this issue, investigators pooled data from three randomized, double-blind trials that involved 34…