An Open-Labeled Study of Rebamipide Treatment in Chronic Gastritis Patients with Dyspeptic Symptoms Refractory to Proton Pump Inhibitors

Abstract

To assess the efficacy of rebamipide therapy in chronic gastritis patients with refractory dyspeptic symptoms, we enrolled 30 patients with chronic gastritis nonresponsive to the antisecretory medications, proton pump inhibitors. Upper gastrointestinal endoscopy was performed in all patients to confirm and evaluate the severity of gastritis by gastric mucosal injury score and the histology by the updated Sydney system before and after treatment with rebamipide 300 mg daily for 8 weeks. At the end of the study, significant improvement in the scores for symptoms (epigastralgia, stomach heaviness, and abdominal fullness) and endoscopic mucosal injury were observed for all patients. The degrees of neutrophil activity in antrum and mononuclear cell inflammation in both body and antrum significantly decreased from baseline. Improvement of gastritis might be the mechanism by which rebamipide prevents gastric mucosal inflammation. In conclusion, rebamipide treatment improved symptom, endoscopic, and histologic features of chronic gastritis in patients with refractory dyspeptic symptoms.

Rebamipide has the potential to reduce the intensity of NSAID-induced small intestinal injury: a double-blind, randomized, controlled trial evaluated by capsule endoscopy

“…Rebamipide has been used across Asia for the treatment of gastric ulcers and gastric lesions such as erosions and edema caused by acute gastritis [14,17,22]. It has been well documented that rebamipide increases endogenous prostaglandin levels, scavenges free radicals, and suppresses inflammation in the gastric mucosa [23][24][25]. Through these actions, rebamipide has also been shown to be useful in preventing NSAID-induced gastrointestinal injuries in clinical studies and animal experiments.…”

“…Through these actions, rebamipide has also been shown to be useful in preventing NSAID-induced gastrointestinal injuries in clinical studies and animal experiments. In a randomized controlled trial of rheumatoid arthritis and osteoarthritis patients carried out in East Asian countries, the effectiveness of rebamipide was shown to equal that of misoprostol in preventing the incidence of gastroduodenal ulcers caused by 12 weeks of NSAID medication [25]. As for NSAID-induced small intestinal injuries, a sequence of events such as an increase in the permeability of epithelial cells due to the direct toxic effect of NSAIDs, bacterial translocation, and inflammation through cytokine activation in the small intestinal mucosa have all been suggested to be key elements in the induction of small intestinal ulceration, in addition to a lack of prostaglandin [23,26,27].…”

Prevention of Traditional NSAID-Induced Small Intestinal Injury: Recent Preliminary Studies Using Capsule Endoscopy

“…Rebamipide has been used across Asia for the treatment of gastric ulcers and gastric lesions such as erosions and edema caused by acute gastritis [27,28,29]. It has been well documented that rebamipide increases endogenous PG levels, scavenges free radicals, and suppresses inflammation in the gastric mucosa [11,30,31]. Through these actions, rebamipide has been also shown to be useful in preventing NSAID-induced gastrointestinal injuries in clinical studies and animal experiments.…”

“…Through these actions, rebamipide has been also shown to be useful in preventing NSAID-induced gastrointestinal injuries in clinical studies and animal experiments. In a randomized controlled trial of rheumatoid arthritis and osteoarthritis patients carried out in East Asian countries, the effectiveness of rebamipide was shown to equal that of misoprostol in preventing the incidence ratio of gastroduodenal ulcers caused by 12 weeks of NSAID medication [31]. In an animal experiment, rebamipide has been shown to inhibit increases in iNOS activity induced by indomethacin, thereby reducing small intestinal injury caused by NSAIDs in rats [32].…”

The Benefits of Combination Therapy with Esomeprazole and Rebamipide in Symptom Improvement in Reflux Esophagitis: An International Multicenter Study

“…In addition, a portion of reflux esophagitis patients have gastritis;6 rebamipide, as an effective therapeutic agent for gastritis, led to effective symptomatic responses and improvement of endoscopic and histologic parameters in chronic gastritis patients with dyspepsia refractory to PPIs 7. Rebamipide is a candidate drug for the reduction of inflammation in the esophageal mucosa of patients with GERD.…”