Can Celecoxib or Helicobacter pylori Eradication Reduce Gastric Lesions?

Regression of precancerous lesions was better with either treatment than with placebo.


Both Helicobacter pylori infection and high levels of cyclooxygenase (COX)-2 have been associated with gastric cancer. To explore whether H. pylori eradication and a selective COX-2 inhibitor can reduce gastric lesions, investigators in China conducted a prospective, randomized, double-blind study involving patients with documented H. pylori infection and histologic evidence of chronic atrophic gastritis, intestinal metaplasia, dysplasia, or indefinite dysplasia.

A total of 1024 patients were randomized to one of four treatments: placebo alone, placebo with 7 days of H. pylori therapy, placebo with 24 months of celecoxib, or 7 days of H. pylori therapy and 24 months of celecoxib. Patients underwent endoscopic biopsies at baseline and after 24 months.

Among the 919 patients who completed treatment and underwent final endoscopic biopsies, regression of gastric lesions occurred in more patients who received celecoxib than placebo (52.8% vs. 41.2%; odds ratio, 1.72; 95% confidence interval, 1.07–2.76) and in more who received H. pylori treatment than placebo (59.3% vs. 41.2%; OR, 2.19; 95% CI, 1.32–3.64). However, combination H. pylori and celecoxib therapy was not superior to placebo. Gastric cancers occurred in nine patients.


Citation(s):

Wong BCY et al. Effects of selective COX-2 inhibitor and Helicobacter pylori eradication on precancerous gastric lesions. Gut 2011 Sep 13; [e-pub ahead of print].