Is Celebrex (celecoxib) safe to use in patients with Barrett's esophagus?

From the Guidelines

Celebrex (celecoxib) can be used in patients with Barrett's esophagus, but with caution, as it is a COX-2 selective inhibitor that causes less gastrointestinal irritation compared to traditional NSAIDs, and its use should be balanced against the potential cardiovascular risks, as noted in studies such as 1. When considering the use of Celebrex in patients with Barrett's esophagus, it is essential to weigh the benefits of pain management against the potential risks, including gastrointestinal irritation and cardiovascular complications.

• The typical dosage of Celebrex ranges from 100-200 mg once or twice daily, depending on the condition being treated, and patients should take it with food and remain upright for at least 30 minutes after taking it to minimize reflux risk, as suggested by general principles of medication administration.
• Patients with Barrett's esophagus should continue their prescribed acid-suppressing medications, such as proton pump inhibitors, while taking Celebrex, as controlling acid reflux remains essential in managing Barrett's esophagus, as emphasized in guidelines like 1 and 1.
• It is crucial to use Celebrex at the lowest effective dose for the shortest duration possible to minimize the risk of cardiovascular complications, as highlighted in studies such as 1.
• The management of Barrett's esophagus involves a comprehensive approach, including endoscopic surveillance, acid suppression, and, in some cases, endoscopic eradication therapy, as outlined in guidelines like 1 and 1.
• In the context of managing patients with Barrett's esophagus, the use of Celebrex should be individualized, taking into account the patient's specific needs, medical history, and the potential risks and benefits of the medication, as informed by studies such as 1.

From the FDA Drug Label

NSAIDs, including celecoxib cause serious gastrointestinal (GI) adverse events including inflammation, bleeding, ulceration, and perforation of the esophagus, stomach, small intestine, or large intestine, which can be fatal Patients with a prior history of peptic ulcer disease and/or GI bleeding who used NSAIDs had a greater than 10-fold increased risk for developing a GI bleed compared to patients without these risk factors

The use of celecoxib in patients with Barrett's esophagus may increase the risk of gastrointestinal bleeding, ulceration, and perforation. To minimize this risk, it is recommended to:

• Use the lowest effective dosage for the shortest possible duration.
• Avoid administration of more than one NSAID at a time.
• Avoid use in patients at higher risk unless benefits are expected to outweigh the increased risk of bleeding.
• Remain alert for signs and symptoms of GI ulceration and bleeding during NSAID therapy 2.

From the Research

Celebrex and Barrett's Esophagus

• There is no direct evidence in the provided studies regarding the use of Celebrex in patients with Barrett's esophagus 3, 4, 5, 6, 7.
• The studies primarily focus on the management of Barrett's esophagus using proton pump inhibitors (PPIs) and the role of acid suppression in chemoprevention 4, 6, 7.
• While PPIs are commonly used to manage Barrett's esophagus, there is no mention of Celebrex, a nonsteroidal anti-inflammatory drug (NSAID), in the context of Barrett's esophagus treatment or management 3, 5.
• It is essential to consider the potential risks and benefits of using Celebrex in patients with Barrett's esophagus, as NSAIDs can have gastrointestinal side effects, but this information is not available in the provided studies 3, 4, 5, 6, 7.

Management of Barrett's Esophagus

• The primary management of Barrett's esophagus involves acid-suppressive medications, such as PPIs, to reduce underlying gastroesophageal reflux disease (GERD) symptoms and surveillance endoscopy every 3 to 5 years 3, 5.
• Endoscopic therapy, including resection and ablation, is effective in treating patients with Barrett's esophagus and dysplasia or early cancer 3.
• The role of chemoprevention in Barrett's esophagus is still being studied, with some evidence suggesting that PPIs may have a cancer-protective effect 6, 7.