Rebamipide plus proton pump inhibitor versus proton pump inhibitor alone in the treatment of endoscopic submucosal dissection-induced gastric ulcer: a meta-analysis of randomized controlled trials

New Prospects of Cytoprotection in the Treatment and Prevention of Gastric and Intestinal Diseases (Resolution of an Expert Council and Literature Review)

Aim. To generalize up-to-date information on the possibilities of cytoprotection in the treatment and prevention of gastric and intestinal diseases, as well as to present the materials of an Expert Council meeting held on February 8, 2020 in Moscow under the support of the Alium company.

General provisions. The conducted Expert Council meeting was aimed at discussing the importance of improving the cytoprotective properties of the gastric and intestinal mucous membrane in the treatment of its lesions. It was shown that Rebamipide exhibits positive effects on various parts of the protective barrier of the gastrointestinal tract (GIT), primarily due to its stimulating action on the production of prostaglandins playing a key role in maintaining the cytoprotective properties of the gastrointestinal mucosa. The possibilities of applying Rebamipide for the treatment and prevention of erosive and ulcerative gastrointestinal lesions caused by non-steroidal anti-inflammatory (NSAIDs) and antithrombotic drugs were demonstrated. In the treatment of gastroesophageal reflux disease, Rebamipide is recommended for patients refractory to therapy with proton pump inhibitors (PPIs) and for those with non-acid reflux. The efficacy of Rebamipide in the treatment of Helicobacter pylori (H. pylori) infection, as well as functional dyspepsia and chronic gastritis, was confirmed.

Conclusions. Rebamipid is a highly effective drug positively affecting various cytoprotection links, thus being suitable for the treatment and prevention of erosive and ulcerative lesions of the gastrointestinal tract, as well as gastroenterological diseases of various etiologies.

Conflict of interest: The Expert Council meeting was supported by the Alium company.

Efficacy of proton pump inhibitors plus rebamipide for endoscopic submucosal dissection-induced ulcers: A Meta-analysis of randomized controlled trials

AIM: To compare the efficacy of proton pump inhibitors (PPIs) plus rebamipide vs PPIs alone for the treatment of ulcers induced by endoscopic submucosal dissection (ESD).

METHODS: Keyword and MeSH searches of PubMed, EMBASE, OVID, Cochrane Library, Wanfang Database and CNKI from the inception of each database to February 2015 were performed to identify all available randomized controlled trials comparing the effects of PPIs plus rebamidide and PPIs alone on healing ulcers after ESD. Two independent reviewers assessed the studies for inclusion and exclusion based on methodological quality criteria.

RESULTS: A total of five studies involving 670 patients were included. The pooled data suggested a significantly higher rate of ulcer healing after ESD among patients treated with PPIs plus rebamipide than those treated with PPIs alone (OR = 2.68, 95%CI: 1.81-3.97). The combination therapy was found to be significantly more effective than the use of PPIs alone for all ESD ulcers greater than 20 mm in size (OR = 4.77, 95%CI: 2.22-10.26). The ulcer reduction rate in the combination group was higher than that in the PPI alone group after four weeks of treatment (MD = 68.39, 95%CI: 35.73-101.05).

CONCLUSION: The results of this meta-analysis indicate that the combination therapy of PPIs plus rebamipide is more efficient than PPI monotherapy in healing ESD-induced ulcer, particularly large ulcers. However, more high-quality trials are needed to confirm these findings.