Rebamipide and its Application in Clinical Practice (Literature Review, Meta-Analysis and Personal Experience), Part II. Eradication of Helicobacter Pylori and Rebamipide
Starostin Boris D
ABSTRACT
Introduction: eradication of Helicobacter pylori (HP) is of great importance in faster scarring of ulcers, preventing recurrence of peptic ulcer disease and its complications, including bleeding, histological regression of acute and chronic gastritis, reducing the severity of atrophy of the gastric mucosa or its elimination with timely treatment, reducing the area of intestinal metaplasia, preventing the development of cancer, possible regression of MALT lymphoma in the early stages, positive effect in unexplained iron deficiency anemia, thrombocytopenic purpura and B12 deficiency anemia, to eliminate rosacea, acne and halitosis. In numerous publications in recent years, there has been a decrease in the effectiveness of anti-Helicobacter therapy (anti-H.p.).
A decrease in the effectiveness of anti-H.p. therapy led to a search for methods to optimize such therapy, one of which is the addition of the mucoprotective drug rebamipide.
The Aim: of our work was to evaluate the impact of the effectiveness of adding rebampide to various anti-H.p. dual therapy, triple therapy and quadruple therapy.
Methods: each topic of the drug’s use was evaluated from the point of view of evidence-based medicine. 16 studies were included for evaluation: 6 with dual therapy, 8 with triple therapy (the study of Vyalov S.S., 2017 was excluded from the analysis due to the fact that it was presented as an abstract and rebamipide was administered at a dose of 100 mg 2 times a day – off lable), and 2 with quadruple therapy.
Results: of the 6 studies dual PPIs-based anti-H.p. therapy, 4 showed no significant differences in H.p. eradication, with p>0.05, while 2 showed significant differences, with p<0.05. But with the total addition of all patients in the groups without rebamipide and with rebamipide and the calculation of the average H.p. eradication rate in the corresponding group: out of 251 patients in the group of anti-Hp regimen without ebamipide, 153 achieved eradication - 61.7%, and in the group with rebamipide out of 368 patients 280 – 75.6% (an increase of 13.9%), the differences are statistically significant, at p<0.01. The metaanalysis of triple PPIs-based anti-H.p. therapy showed that when comparing the rebamipide groups with the control group, none of the studies showed a significant difference in the effectiveness of H. pylori eradication, p>0.05. In the total analysis, the number of patients who participated in the study groups with rebamipide was 254, compared to 159 patients in the control groups without rebamipide. The mean eradication rate of H. pylori in the ebamipide groups was 92.2%, compared to 84.9% in the control groups without rebamipide, with a significant difference at p<0.05. The addition of rebampide to quadruple therapy with bismuth tripotassium dicitrate increases the H. pylori eradication rate to more than 90%, promotes earlier relief of the disease symptoms, and eliminates endoscopic changes in the gastric and duodenal mucosa.
Conclusions: thus, the inclusion of rebamipide in the anti-Hp regimen creates a trend towards increased eradication of Helicobacter pylori infection, which is most pronounced when dual anti-Hp therapy is administered. However, the main effect of rebamipide is its influence on the protective abilities of the epithelium of the stomach and duodenum, reducing the severity of chronic gastritis activity, which is very important for further treatment after eradication.
