The Usefulness of Combination Therapy Consisting of PPI and Rebamipide, a Gastroprotective Agent, for Gastric Ulcers Following ESD

Abstract

Background: ESD (endoscopic submucosal dissection) has been recognized as a as a remarkably effective endoscopic therapy for early gastric cancer, which allows the removal of lesions en bloc. For ESD-induced gastric ulcers, proton pump inhibitor (PPI) has been reported as a more effective drug than H2 receptor antagonist for the avoidance of complications such as bleeding or perforation of the giant ulcer. On the other hand, Rebamipide is a gastroprotective agent and has been recognized as an effective drug for injured gastric mucosa. In this study, we investigated retrospectively the usefulness of Rebamipide for gastric ulcer after ESD. Patients and Methods: Between June 2005 and March 2006, a total of 53 patients underwent ESD for early gastric cancer or adenoma in our unit. All patients were treated with intravenous PPI on the day of ESD. For the following 4 weeks, 32 patients were treated with only PPI p.o. (omeprazol 20 mg per a day, ransoprazol 30 mg per a day, or pantoprazol 20 mg per a day: PPI group) and 21 patients were treated with PPI p.o. and Rebamipide, 300 mg per a day, p.o. (PPI + R group). The median age of the PPI group was 73 (range: 56-87), the sex ratio was 23: 9 (male to female), that of the PPI + R group was 74 (range: 45-86), and the sex ratio was 15:6 (male to female). After 1 week and 4 weeks, endoscopies were performed in both groups for comparative evaluation of the ulcers. Results: Significant differences were not revealed between the two groups in regard to the positions and area of ESD. After 1 week, deep ulceration was found in 16 patients (50%) of the PPI group and in 1 patient (4.4%) of PPI + R group. Strong edema around the ulcer was observed in 11 cases (33.4%) of the PPI group and in 2 cases (9.5%) of the PPI + R group. After 4 weeks, ulcers in the active stage (A1, A2) and the H2 stage were found in 63.6% of the PPI group. On the other hand, no active-stage ulcer was found in the PPI + R group, while in this group small H2 stage ulcers were found in 36.8%. Conclusion: Combination therapy consisting of PPI and Rebamipid is more effective for enhanced healing of ulcer after ESD compared with PPI only.