GASTROINTESTINAL TOLERABILITY OF MELOXICAM AND PIROXICAM - A DOUBLE-BLIND PLACEBO-CONTROLLED STUDY

Aims The aim oi the study was to compare the effects of meloxicam and piroxicam on the gastroduodenal mucosa in healthy adults. Methods Fort y-four healthy volunteers were given a 28 day course of either meloxic am 15 mg, piroxicam 20 mg or placebo. Damage to the oesophageal, gastr ic and duodenal mucosa was assessed, mucosal blood flow (MBF) measured at endoscopy and biopsies taken for prostaglandin content and microsc opic assessment of damage before NSAID administration and during days 1, 7 and 28 of continued intake. Results Maximal macroscopic gastric m ucosal damage (median grade + IQR) occurred within 24 h of piroxicam a dministration, the damage score increasing from 0 to 2.5 (0-3) (P=0.02 ) at day 1 before falling to 2.0 (0-2) at day 7 and 0 (0-1) at day 28 with resolution of damage observed in six out of the seven subjects wh o sustained acute injury. No significant macroscopic gastric damage oc curred in either of the two other groups although some minor damage wa s observed in seven subjects taking placebo and five taking meloxicam. There was a trend towards piroxicam causing more acute gastric damage than meloxicam (P=0.06). Baseline antral, body and duodenal MBF were similar in all three groups. No significant changes occurred in any of the groups on any of the visits. There were also no changes in gastri c mucosal prostaglandin content in any group. Conclusions These observ ations suggest that meloxicam causes little acute damage to the upper gastrointestinal tract and piroxicam causes some acute gastric injury but such damage resolves in most subjects by 28 days.