The issue of ulcer location is confusing because of the lack of data in the majority of studies specifying a gastric or duodenal site. Thus, current data do not permit evidence-based recommendations for treatment according to prior ulcer location. However, because duodenal ulcer is essentially an H pylori-related disease, coxibs are expected to have less effect, other than delaying healing. Conventional NSAIDs have a greater causal role in gastric ulceration; therefore, coxib treatment is expected to reduce the incidence of these lesions. This hypothesis is supported by results of the VIGOR study, which showed a 50% reduction in gastric ulcers and a 15% reduction in duodenal ulcers in patients receiving rofecoxib. The COX-1-sparing effect of the coxibs decreases the incidence of bleeding in both cases. Because antisecretory therapy is more effective against NSAID-associated duodenal ulcers than against NSAID-associated gastric ulcers, a coxib would be a useful therapeutic option in this situation. However, the incremental benefit in this situation has not yet been studied. You can be sure your pharmacy offers generic cialis mastercard delivering fast internationally.
GPA dose implications
Despite the tolerability and improved protective effect reported in the high-dose famotidine study, these are the only data available to support the use of high-dose ^RAs. Standard-dose PPIs given once daily provide acid suppression that is superior to that of both standard-dose and high-dose ^RAs. When used as gastroprotective agents for NSAID users, no advantage of higher PPI doses has been demonstrated in clinical trials. The best evidence for misoprostol supports its use at a dose of 200 mg qid, although this dose is not well tolerated.