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Randomised controlled trial
Multicentre trial in people with arthritis finds increased risk of clinically significant gastrointestinal events with diclofenac plus omeprazole compared with celecoxib
  1. Alaa Rostom
  1. Division of Gastroenterology, Departments of Medicine and Community Health Science, University of Calgary, Calgary, Alberta, Canada
  1. Correspondence to Alaa Rostom
    University of Calgary, 3280 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; arostom{at}

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Although traditional non-steroidal anti-inflammatory drugs (tNSAIDs) have been recognised to have adverse effects throughout the gastrointestinal (GI) tract, emphasis has historically centred on reducing their upper GI ulcerogenic effects.1 Randomised trials and systematic reviews have shown that misoprostol and proton pump inhibitors (PPIs) are effective at reducing the risk of tNSAID-related upper GI toxicity. The tNSAID+PPI strategy emerged as the preferred strategy for several reasons including a favourable side effect profile. Over the last 10 years, the focus has shifted towards using cyclooxygenase-2 (COX-2) inhibitors alone as another effective strategy to reduce upper GI toxicity. COX-2 inhibitors, however, have been associated with other adverse effects, and many have been withdrawn from various markets.1 Chan …

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  • Competing interests AR has participated in an Ad board for Astra Zeneca.