Acute gastrointestinal permeability responses to different non-steroidal anti-inflammatory drugs

Abstract

Background and aims: Non-steroidal anti-inflammatory drugs (NSAIDs) cause gastrointestinal damage both in the upper and lower gastrointestinal tract. New anti-inflammatory drugs have been developed in an attempt to improve their gastrointestinal side effect profile. Our objective was to compare the effect on gastrointestinal permeability of acute equieffective doses of four different NSAIDs; three were designed to reduce gastrointestinal mucosal injury.

Materials: Healthy volunteers underwent sugar tests in a randomised fashion, 15 days apart, at: (1) baseline; (2) after two days of 75 mg slow release (microspheres) indomethacin; (3) after two days of 7.5 mg oral meloxicam which preferentially inhibits cyclooxygenase 2; and (4) after two days of 750 mg naproxen. A subgroup of subjects was tested after two days of 200 mg celecoxib. In each test, subjects ingested a solution containing sucrose, lactulose, and mannitol and sucralose, to evaluate gastroduodenal, intestinal, and colonic permeability, respectively.

Results: Gastric permeability was significantly affected by naproxen (p<0.05) but not by slow release indomethacin, meloxicam, or celecoxib. Intestinal permeability was significantly increased by the first three NSAIDs (p<0.05) but not by celecoxib. Abnormal lactulose/mannitol ratios were observed in 42% of meloxicam treatments, in 62% during indomethacin, and in 75% of subjects treated with naproxen. Finally, colonic permeability, as measured by sucralose, was not significantly increased by any of the four drugs.

Conclusion: Our study provides evidence that the newly developed NSAIDs reduce gastric mucosal permeability significantly. However, most produced significant alteration of small intestinal permeability. In contrast, our results suggest that celecoxib seems to exhibit the most desirable gastrointestinal side effect profile.

Figure 1

Gastrointestinal permeability following meloxicam, slow release (SR) indomethacin, and naproxen in healthy subjects. Results obtained from 19 subjects at baseline, after two days of 7.5 mg/day meloxicam, 75 mg/day SR indomethacin, and 750 mg/day naproxen. (A) Excretion of sucrose. (B) Lactulose/mannitol ratio. (C) Excretion of sucralose. Data are presented as boxplots with the small boxes representing median values, the large boxes 50% of values, and the whiskers the range of values. Fractional excretion of sucrose was increased after naproxen administration; all non-steroidal anti-inflammatory drugs caused a significant increase in the lactulose/mannitol ratio. *p<0.05 versus baseline values.

Figure 2

Gastrointestinal permeability following celecoxib. Results obtained from nine subjects at baseline, after two days of 200 mg/day celecoxib, and after two days of 750 mg/day naproxen. (A) Excretion of sucrose. (B) Lactulose/mannitol ratio.(C) Excretion of sucralose. Data are presented as boxplots with the small boxes representing median values, large boxes 50% of values, and whiskers the range of values. Fractional excretion rates of sucrose were only increased after naproxen administration. *p<0.05 versus baseline values.