Brief Article
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World J Gastroenterol. Sep 14, 2013; 19(34): 5706-5712
Published online Sep 14, 2013. doi: 10.3748/wjg.v19.i34.5706
Efficacy of treatment with rebamipide for endoscopic submucosal dissection-induced ulcers
Masaki Takayama, Shigenaga Matsui, Masanori Kawasaki, Yutaka Asakuma, Toshiharu Sakurai, Hiroshi Kashida, Masatoshi Kudo
Masaki Takayama, Shigenaga Matsui, Masanori Kawasaki, Yutaka Asakuma, Toshiharu Sakurai, Hiroshi Kashida, Masatoshi Kudo, Department of Gastroenterology and Hepatology, Kinki University, Osaka 589-8511, Japan
Author contributions: Takayama M and Matsui S contributed equally to this work; Takayama M, Matsui S, Kawasaki M, Asakuma Y, Sakurai T, Kashida H and Kudo M designed the research; Takayama M and Matsui S performed the research; Takayama M and Matsui S analyzed the data; Takayama M wrote the paper.
Correspondence to: Masaki Takayama, MD, Department of Gastroenterology and Hepatology, Kinki University, 377-2 Ohno-Higashi, Osaka-Sayama, Osaka 589-8511, Japan. masaki0742@yahoo.co.jp
Telephone: +81-72-3660221 Fax: +81-72-3672880
Received: June 9, 2013
Revised: July 25, 2013
Accepted: August 8, 2013
Published online: September 14, 2013
Processing time: 135 Days and 20.7 Hours
Abstract

AIM: To prospectively compare the healing rates of endoscopic submucosal dissection (ESD)-induced ulcers treated with either a proton-pump inhibitor (PPI) or rebamipide.

METHODS: We examined 90 patients with early gastric cancer who had undergone ESD. All patients were administered an intravenous infusion of the PPI lansoprazole (20 mg) every 12 h for 2 d, followed by oral administration of lansoprazole (30 mg/d, 5 d). After 7-d treatment, the patients were randomly assigned to 2 groups and received either lansoprazole (30 mg/d orally, n = 45; PPI group) or rebamipide (300 mg orally, three times a day; n = 45; rebamipide group). At 4 and 8 wk after ESD, the ulcer outcomes in the 2 groups were compared.

RESULTS: No significant differences were noted in patient age, underlying disease, tumor location, Helicobacter pylori infection rate, or ESD-induced ulcer size between the 2 groups. At both 4 and 8 wk, the healing rates of ESD-induced ulcers were similar in the PPI-treated and the rebamipide-treated patients (4 wk: PPI, 27.2%; rebamipide, 33.3%; P = 0.5341; 8 wk: PPI, 90.9%; rebamipide, 93.3%; P = 0.6710). At 8 wk, the rates of granulation lesions following ulcer healing were significantly higher in the PPI-treated group (13.6%) than in the rebamipide-treated group (0.0%; P = 0.0103). Ulcer-related symptoms were similar in the 2 treatment groups at 8 wk. The medication cost of 8-wk treatment with the PPI was 10945 yen vs 4889 yen for rebamipide. No ulcer bleeding or complications due to the drugs were observed in either treatment group.

CONCLUSION: The healing rate of ESD-induced ulcers was similar with rebamipide or PPI treatment; however, rebamipide treatment is more cost-effective and prevents granulation lesions following ulcer healing.

Keywords: Early gastric cancer; Rebamipide; Endoscopic submucosal dissection; Gastric ulcer; Proton-pump inhibitor

Core tip: In this prospective randomized, parallel-controlled study, we demonstrated that rebamipide monotherapy was as effective as proton-pump inhibitor (PPI) in the healing of endoscopic submucosal dissection-induced ulcers, regardless of the location of the resected cancer, the degree of atrophic gastritis, or the presence of Helicobacter pylori infection. In addition, rebamipide treatment is more cost-effective and results in a better quality of ulcer healing compared with the PPI lansoprazole.