Obstruction diclofenac

The same warning applies to evaluation of the incidence of complicated ulcers (bleeds, perforation, and obstructions). The incidence of these serious events with celecoxib was 2.7% (11 events) versus 5% (20 events) in patients taking diclofenac or ibuprofen, a non-significant difference. 

To study effects on clinically important GI complications with celecoxib, the CLASS study used celecoxib (400 mg twice daily, or twice the highest FDA-approved dose) compared to diclofenac and ibuprofen at standard dose. Celecoxib use was reported to be associated with a reduced incidence for the combined end point of symptomatic ulcers and ulcer complications (perforations, gastric outlet obstruction, or bleeding). Some subjects also used aspirin for car-dioprotection, but there is concern that GI safety of COX-2 inhibitors is blunted with use of concomitant aspirin (even 30 mg of aspirin can suppress gastric prostaglandin prodnction)." For patients taking aspirin and celecoxib, nicer complications were higher than with celecoxib only, but lower than with traditional NSAIDs. 

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