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PPIs increase risk for NSAID-induced small bowel injury
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Proton pump inhibitors were found to increase the risk for small bowel injury in patients taking NSAIDs in a Japanese trial.
“Recent clinical trials using [capsule endoscopy] have shown considerably high incidence of small bowel injuries (60% to 80%) in subjects who take nonselective NSAIDs and PPIs simultaneously,” the researchers wrote. “In order to examine the influence of concomitant use of PPIs on NSAID-induced small bowel injury in humans, we performed a prospective, double-blind, randomized controlled study.”
From October 2012 to September 2013, the investigators randomly assigned 57 healthy volunteers at a single center to receive either 200-mg celecoxib twice daily plus placebo, or 200-mg celecoxib twice daily plus 20-mg rabeprezole once daily for 2 weeks. All participants underwent capsule endoscopy (EndoCapsule, Olympus Medical Systems) at baseline and the end of the treatment period, and the incidence of ulcers or erosions observed during the second capsule endoscopy served as the primary endpoint.
The researchers found small bowel injury occurred significantly more often in individuals who received PPIs compared with those who received placebo (44.4% vs. 16.7%; P = .04), corresponding to a significantly increased risk for small bowel injury (RR = 2.67; 95% CI, 1.08-6.58). Moreover, the PPI group had higher numbers of erosions per individual (P = .02), and mucosal injuries in the jejunum were observed only in the PPI group (26% vs. 0%; P = .003).
“In conclusion, our prospective study demonstrated that the incidence of small bowel injury was higher in subjects treated with celecoxib plus rabeprazole than those treated with celecoxib alone,” the researchers concluded. “It thus can be suggested PPIs increase the risk of small bowel injury by NSAIDs including COX-2 selective inhibitors, while its clinical significance remains to be clarified.” – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures.
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