Evaluating PN 400 (VIMOVO) in Reducing Gastric Ulcers in High Risk Subjects Compared to Arthrotec

Inclusion Criteria: 1. Male or non-pregnant female subjects, 18 years and older with a history of osteoarthritis, rheumatoid arthritis, ankylosing spondylitis or other medical condition expected to require daily NSAID therapy for at least 6 months, with a documented history of an ulcer related serious upper gastrointestinal event such as bleeding, perforation or obstruction 2. Female subjects are eligible for participation in the study if they are of: * Non-childbearing potential (i.e., physiologically incapable of becoming pregnant); * Childbearing potential, have a negative pregnancy test at screening, and at least one of the following applies or is agreed to by the subject: * Female sterilization or sterilization of male partner; or, * Hormonal contraception by oral route, implant, injectable, vaginal ring; or, * Any intrauterine device (IUD) with published data showing that the lowest expected failure rate is less than 1% per year; * Double barrier method (2 physical barriers or 1 physical barrier plus spermicide); or * Any other method with published data showing that the lowest expected failure rate is less than 1% per year 3. Each subject must be able to understand and comply with study procedures required of a subject and is able and willing to provide written informed consent prior to any study procedures being performed Exclusion Criteria: 1. History of hypersensitivity to esomeprazole or to another proton-pump inhibitor 2. History of allergic reaction or intolerance to any NSAID (including aspirin) and/or a history of NSAID-induced symptoms of asthma, rhinitis, and/or nasal polyps 3. Positive test result for H. pylori at screening 4. Participation in any study of an investigational treatment in the 4 weeks before screening 5. Presence of uncontrolled acute or chronic medical illness, e.g. gastrointestinal disorder, hypertension, diabetes, thyroid disorder, depression and/or infection that would endanger a subject if they were to participate in the study 6. Gastrointestinal disorder or surgery leading to impaired drug absorption 7. Evidence of uncontrolled, or unstable cardio- or cerebrovascular disorder, which in the investigator's opinion would endanger a subject if they were to participate in the study 8. Schizophrenia or bipolar disorder 9. Use of any excluded concomitant medication (see Section 9.2) 10. A recent history (in the past 3 months) suggestive of alcohol or drug abuse or dependence, including overuse/abuse of narcotics for management of pain 11. Serious blood coagulation disorder, including use of systemic anticoagulants 12. Screening endoscopy showing \>10 erosions or any gastric or duodenal ulcer at least 3 mm in diameter with depth 13. Screening laboratory ALT or AST value \> 2 times the upper limit of normal 14. Estimated creatinine clearance \< 50 ml/min 15. Other than noted specifically, any screening laboratory value that is clinically significant in the investigator's opinion and would endanger a subject if they were to participate in the study 16. History of malignancy, treated or untreated, within the past 5 years, with the exception of successfully treated basal cell or squamous cell carcinoma of the skin