Institute of Basic Medical Sciences, National Cheng Kung University, Hsinchu, Taiwan.
J Gastroenterol Hepatol. 2010 Jan;25(1):48-53. doi: 10.1111/j.1440-1746.2009.05974.x. Epub 2009 Sep 27.
The intestinal metaplasia (IM) has overexpressions of cyclooxygenase-2 (COX-2) and beta-catenin. This pilot study assessed whether celecoxib, a selective COX-2 inhibitor, could regress IM that persisted long term after Helicobacter pylori eradication.
Thirty-three patients with H. pylori eradication were enrolled in the present study due to the persistence of IM after a 3-year follow up. These patients received celecoxib 200 mg/day for 8 weeks, and were serially checked for levels of blood urea nitrogen and creatinine once per 2 weeks. After 8-week celecoxib treatment, IM regression was assessed by panendoscopy. The gastric specimens, taken before and after celecoxib, were immunochemically stained for COX-2 and beta-catenin.
The intention-to-treat and per-protocol analyses to the rates of IM regression by 8-week celecoxib treatment were 24.2% (8/33) and 28.6% (8/28), respectively. All enrolled patients had no renal impairment. Even in the patients without total IM regression, mean IM scores in the antrum decreased after 8-week celecoxib treatment (P = 0.007). The patients with complete regression of IM after 8-week celecoxib treatment had a significantly lower COX-2 expression, but not beta-catenin expression, at enrollment than those patients without IM regression (P = 0.031).
Short-term celecoxib treatment can be safe and promising to regress long-term persistent IM after H. pylori eradication.
肠上皮化生（IM）中环氧合酶-2（COX-2）和β-连环蛋白表达过度。本研究旨在评估选择性 COX-2 抑制剂塞来昔布是否能使幽门螺杆菌根除后长期持续的 IM 消退。
由于在 3 年随访后仍存在 IM，本研究招募了 33 例 H. pylori 根除后发生 IM 的患者。这些患者接受塞来昔布 200mg/天治疗 8 周，每 2 周检查一次血尿素氮和肌酐水平。塞来昔布治疗 8 周后，通过全内镜检查评估 IM 消退情况。用免疫化学方法检测 COX-2 和β-连环蛋白，检测塞来昔布治疗前后的胃标本。
意向治疗和按方案分析显示，8 周塞来昔布治疗的 IM 消退率分别为 24.2%（33 例中的 8 例）和 28.6%（28 例中的 8 例）。所有入组患者均无肾功能不全。即使在 IM 无完全消退的患者中，8 周塞来昔布治疗后胃窦部 IM 评分也降低（P=0.007）。8 周塞来昔布治疗后 IM 完全消退的患者与未消退的患者相比，COX-2 表达明显降低，但β-连环蛋白表达无差异（P=0.031）。
短期塞来昔布治疗可能安全、有前景地使幽门螺杆菌根除后长期持续的 IM 消退。
