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Patients at high risk for upper gastrointestinal (GI) ulceration who require nonsteroidal anti-inflammatory drugs (NSAIDs) often receive either the selective cyclooxygenase (COX)-2 inhibitor celecoxib or a nonselective NSAID plus a proton-pump inhibitor (PPI). These two approaches were compared in a double-blind randomized trial, sponsored by the maker of celecoxib, involving 4500 patients with arthritis. All patients had elevated risk for GI complications (age ≥60 or history of peptic ulcer or GI bleeding).
Patients received either celecoxib (200 mg twice daily) or the combination of diclofenac (75 mg twice daily) plus omeprazole (20 mg daily). Because NSAIDs are associated with ulceration throughout the GI tract, the researchers used a com…