Effects of selective COX-2 inhibitor and Helicobacter pylori eradication on precancerous gastric lesions

Wong, Benjamin C. Y.; Lian Zhang; Jun-ling Ma; Kai-feng Pan; Ji-you Li; Lin Shen; Wei-dong Liu; Guo-shuang Feng; Xiao-dong Zhang; Jie Li; Ai-ping Lu; Xia, Harry H. X.; Shiukum Lam; Wei-cheng You
June 2012
Gut;Jun2012, Vol. 61 Issue 6, p812
Academic Journal
Objective Helicobacter pylori infection and overexpression of cyclo-oxygenase-2 (COX-2) are associated with gastric cancer and its precursors. To evaluate the effect of a selective COX-2 inhibitor alone and combined with H pylori eradication on the evolution of precancerous gastric lesions, a randomised, placebocontrolled trial was conducted in Linqu County, Shandong Province, China. Methods A total of 1024 participants aged 35e64 years with H pylori infection and advanced gastric lesions were randomly assigned in a factorial design to two interventions or placebo: anti-H pylori treatment for 7 days, and a COX-2 inhibitor (celecoxib) for 24 months. The effects of the interventions were evaluated by the regression or progression of advanced gastric lesions. Results Of the 1024 participants who received anti-H pylori treatment or placebo, 919 completed a subsequent 24-month treatment with celecoxib or placebo. The H pylori eradication rate by per-protocol analysis was 78.2%. Compared with placebo, the proportions of regression of gastric lesions significantly increased in the celecoxib treatment (52.8% vs 41.2%) and anti-H pylori treatment (59.3% vs 41.2%) group, and OR by perprotocol analysis was 1.72 (95% CI 1.07 to 2.76) for celecoxib and 2.19 (95% CI 1.32 to 3.64) for H pylori eradication. No statistically significant effect was found for H pylori eradication followed by celecoxib on the regression of advanced gastric lesions (OR 1.48, 95% CI 0.91 to 2.40). Conclusion This population-based intervention trial revealed that celecoxib treatment or H pylori eradication alone had beneficial effects on the regression of advanced gastric lesions. No favourable effects were seen for H pylori eradication followed by celecoxib treatment. INSET: Significance of this study.


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