Side Effects of Celecoxib: Gastrointestinal Concerns and More

Side effects of Xeljanz?

Hello Doctor: I am a patient with ankylosing spondylitis, currently 20 years old.
I started taking Celebrex a year ago, and recently, four days ago, I began experiencing bloody stools.
The colorectal surgeon diagnosed it as hemorrhoids and has prescribed suppositories for treatment.
However, since that doctor is not a rheumatologist, I am concerned that he may not be familiar with Celebrex.
The medication's leaflet mentions a very small risk of gastrointestinal bleeding and hemorrhoids as side effects.
I am worried that my condition might not be hemorrhoids but rather a more serious lower gastrointestinal bleeding.
Therefore, I would like to ask the doctor: 1) Is it true that the gastrointestinal bleeding side effects mentioned in the Celebrex leaflet are mostly related to upper gastrointestinal bleeding, while lower gastrointestinal bleeding is relatively rare (assuming hemorrhoids do not count as lower gastrointestinal bleeding)? I think this way because my rheumatologist has emphasized that I should occasionally check my stool for black stools while taking the medication.
2) Recently, my school (sophomore year) conducted a health check, and my ALT level was 34.
Over the past year of taking Celebrex, my ALT levels during follow-up blood tests have generally ranged from 21 to 12.
Earlier, during a health check in my first year of high school, my ALT was 25.
Should I be concerned that my liver might be affected by the medication? 3) Additionally, could you please clarify if hsCRP is simply a more precise measurement than CRP? For example, in the same blood sample, hsCRP might show 0.765 while CRP shows 0.76, indicating that hsCRP is just more accurate to more decimal places? Thank you, Doctor.

Ting, 20~29 year old female. Ask Date: 2022/02/16

Dr. Zeng Guosen reply Internal Medicine

Hello, netizen.
1) Yes, but Celecoxib is one of the anti-inflammatory pain medications with relatively low bleeding side effects.
2) An ALT level of 34 is within the normal range, so there is no need to worry as long as it is within normal limits.
3) Generally, the CRP test can detect CRP levels greater than 0.5 mg/dL during infection or tissue inflammation, but it cannot accurately detect changes in low concentrations (<0.3 mg/dL) of CRP.
These low concentration changes in CRP are closely related to the occurrence of cardiovascular diseases.
hsCRP, which stands for high sensitivity C-reactive protein, differs from traditional CRP as it uses a more sensitive method to detect CRP levels below 0.3 mg/dL (which is considered normal).
If the value is greater than 0.5 mg/dL, the results of both tests are comparable.
Thank you.

Reply Date: 2022/02/16

More Info

Celecoxib, commonly known by the brand name Celebrex, is a nonsteroidal anti-inflammatory drug (NSAID) that is often prescribed for conditions such as osteoarthritis, rheumatoid arthritis, and ankylosing spondylitis. While it is considered to be less harmful to the gastrointestinal (GI) tract compared to traditional NSAIDs, it is not entirely free from potential side effects, particularly concerning the gastrointestinal system.

1. Gastrointestinal Bleeding and Side Effects
Regarding your concern about gastrointestinal bleeding, it is true that while the risk of upper GI bleeding is more commonly associated with NSAIDs, lower GI bleeding can also occur, albeit less frequently. The gastrointestinal side effects of Celecoxib can include abdominal pain, dyspepsia, and in rare cases, gastrointestinal bleeding. The package insert for Celecoxib does mention the potential for both upper and lower GI complications, but the majority of reported cases tend to be upper GI issues, such as peptic ulcers or gastritis.
Given your recent experience with blood in your stool, it is essential to take this symptom seriously. While hemorrhoids (internal or external) can cause blood in the stool, it is crucial to rule out more severe conditions, such as diverticulosis or inflammatory bowel disease, especially since you are on Celecoxib. If you notice persistent blood in your stool, it is advisable to seek further evaluation from a gastroenterologist.

2. Liver Function Concerns
As for your liver function tests, an ALT (alanine aminotransferase) level of 34 is within the normal range for most laboratories, which typically consider values up to 40 U/L as normal. Your previous ALT levels also indicate stability over time. While some NSAIDs can affect liver function, Celecoxib is generally well-tolerated in terms of hepatic safety. However, if you have any concerns about liver function, especially with a history of elevated liver enzymes, it would be prudent to discuss this with your healthcare provider. Regular monitoring of liver function tests is advisable if you are on long-term medication.

3. Understanding hsCRP vs. CRP
Regarding your question about hsCRP (high-sensitivity C-reactive protein) and CRP (C-reactive protein), both tests measure inflammation in the body, but they do so with different levels of sensitivity. hsCRP is more sensitive and can detect lower levels of inflammation, making it useful for assessing the risk of cardiovascular disease. In contrast, standard CRP tests are typically used to detect significant inflammation due to infections or chronic inflammatory diseases. The values you mentioned (0.765 for hsCRP and 0.76 for CRP) indicate that hsCRP can provide a more precise measurement of inflammation, which is particularly useful in a clinical setting for risk stratification.

Conclusion
In summary, while Celecoxib is a useful medication for managing inflammation and pain, it does carry some risks, particularly concerning gastrointestinal health. Given your symptoms of blood in the stool, it is crucial to follow up with your healthcare provider to ensure that you receive appropriate care and monitoring. Regular liver function tests and understanding the implications of inflammatory markers like hsCRP can provide valuable insights into your overall health. Always communicate any new or worsening symptoms to your healthcare provider to ensure timely intervention and management.

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