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Heart protection has become more important than safeguarding the GI tract, but this, in turn, can make regimens more difficult and more expensive.
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When physicians make choices about how to treat pain, preventing gastrointestinal bleeding is no longer a priority on the list of factors they consider. Protecting the heart is, according to an expert panel at Digestive Disease Week held in Chicago last month. This event is an annual joint meeting of the American Assn. for the Study of Liver Diseases, the American Gastroenterological Assn., the American Society of Gastrointestinal Endoscopy, and the Society for Surgery of the Alimentary Tract.
"When physicians are selecting an NSAID [consults with gastroenterologists] are not as important because it's not about protecting the GI any more," said James Scheiman, MD, a gastroenterologist and director of the Endoscopic Ultrasound Program at the University of Michigan Medical School, Ann Arbor. "In 2005, the heart has got to come first."
This mind-set is the result of the controversy over the use of COX-2 inhibitors. Since both Vioxx (rofecoxib) and Bextra (valdecoxib) have been withdrawn from the market and stronger warnings have been placed on Celebrex (celecoxib) -- all because of increased cardiovascular risks associated with long-term use -- physicians and patients are returning to the older nonsteroidal anti-inflammatory drugs.
"We're seeing less and less use of COX-2s except for highly selected patients," said Dr. Scheiman....
Post-COX-2, pain relief strategies
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