The Comparison of Novel Acid Pump Antagonist and Proton Pump Inhibitor for the Treatment of Iatrogenic Ulcer Caused By Endoscopic Submucosal Dissection

Abstract

Back ground: Acid pump antagonist(revaprazan)and Proton pump inhibitor(PPI) have pH-independent effects on ulcer healing. After wounding, addition of PPI promotes cell restitution rate and vessel regeneration and maturation. A new drug, revaprazan, is known to have mucosal protecting ability by inhibiting secretion of pepsinogen and increasing prostaglandin concentration. It was reported that revaprazan had similar effects with PPI in gastric ulcer healing. However, there were few reports about the effectiveness of revaprazan for the healing of gastric ulcer developed by endoscopic submucosal dissection (ESD). Aim: The aim of this study was to compare the effects of rebeprazole and revaprazan for the healing of ESD induced ulcers. Methods: After ESD, patients were divided by two groups who were assigned to take either rabeprazole (20mg/day) or revaprazan (200mg/day). Healing status of ulcer was examined by EGD after 8 weeks of treatment. The ulcer stages were assessed by using a six-stage system proposed by Sakita and Fukutomi. The size and stage of ulcer were compared between two groups. Results: There were 30 and 47patients in revaprazan and rabeprazole groups respectively. The baseline characteristics such as age, sex, size and location of ulcer, tissue size and histopathology were not significantly different between both groups. 97% and 100% of the patients showed S1 stage after 8 weeks of treatment in revaprazan and rabeprazole group, respectively. In the revaprazan group, only one patient showed H2 stage. He was 54years old with 4cm sized post ESD ulcer, type IIa EGCA and well differentiated adenocarconoma. No serious adverse effects occurred during the treatment period in both groups. Conclusion: Revaprazan and rabeprazole are both safe and effective for the treatment of ESD induced ulcer.