Long-term Celecoxib can Prevent the Progression of Persistent Gastric Intestinal Metaplasia After H. pylori Eradication

Background and Aim Intestinal metaplasia (IM) has overexpressions of COX-2. Short-term 8-week celecoxib, a selective COX-2 inhibitor, exerts a preliminary hint to improve regression in part for persistent IM after Helicobacter pylori eradication. This study further validated whether or not a prolonged duration of celecoxib of up to 1year can be safe and effective. Methods One hundred and forty patients, with persistent IM after H.pylori eradication for 1year, were included with half of them receiving celecoxib 200mg/day for 12months and the other half serving as controls. Each patient received serial checkups of blood creatinine levels every 4months. After the 1-year follow-up, panendoscopy was repeated to assess the IM regression. The serial gastric specimens, taken before and after celecoxib therapy, were immunochemically stained for COX-2. Results The intention-to-treat (ITT) and per-protocol (PP) analyses to the rates of IM regression were higher in the celecoxib group than in the controls (ITT: 44.3% [31/70] vs 14.3% [10/70], p<.001; and PP: 51.7% [31/60] vs 16.1% [10/62], p<.001). All enrolled patients had no renal impairment during follow-up. Even in the patients without IM regression, the mean IM scores and COX-2 expressions were significantly more decreased in the celecoxib group than in the controls (p<.005). Conclusion One year 200-mg celecoxib daily be safely administered to improve the regression or prevent the progression of persistent IM after H.pylori eradication.