title: Contributing factors to gastric ulcer healing after endoscopic submucosal dissection including the promoting effect of rebamipide.
abstract: BACKGROUND
  The healing process for artificial ulcers resulting from endoscopic submucosal dissection (ESD) for gastric cancer is not understood.
  
  
  OBJECTIVE
  To clarify factors that promote healing and the additional healing effects of rebamipide, we conducted a randomized controlled trial to compare proton pump inhibitor (PPI) and combination PPI plus rebamipide treatments.
  
  
  METHODS
  One hundred and seventy patients with early gastric cancers that had undergone ESD were enrolled. Follow-up endoscopy was scheduled at 4-6 weeks after ESD. We assessed marginal healing and basal healing independently by endoscopic observation. Marginal healing was determined by a regenerating epithelium and/or converging folds around the periphery of the ulcer. Basal healing was declared when the ulcer was covered by white coat thinning such that basal granulation could be seen. The sizes of the artificial ulcers were divided into normal size (area <1,200 mm(2)) or large size (area ≥ 1,200 mm(2)).
  
  
  RESULTS
  Initial ulcer size and duration after ESD were significantly correlated with both marginal and basal healing rates by univariate analysis. The marginal healing rate of antral lesions was higher than that of body lesions. Multivariate analysis showed a large-sized ulcer was the only significant predictor of delayed healing, with delayed healing defined as no observed marginal or basal healing (p < 0.0001). Subgroup analysis for the effect of rebamipide on large-sized ulcers showed a significantly higher rate of basal healing in the combination PPI and rebamipide group (p = 0.015).
  
  
  CONCLUSIONS
  Healing in ESD-induced ulcers was dependent on the initial ulcer size. In large-sized ulcers, rebamipide promotes basal healing.
authors.affiliation: Department of Endoscopy, Niigata University Medical and Dental Hospital, 1-757 Asahimachi-dori, Chuo-ku, Niigata 951-8520, Japan. masakoba@med.niigata-u.ac.jp
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Manabu
authors.initials: M
authors.lastname: Takeuchi
authors.forename: Satoru
authors.initials: S
authors.lastname: Hashimoto
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Mizuno
authors.forename: Yuichi
authors.initials: Y
authors.lastname: Sato
authors.forename: Rintaro
authors.initials: R
authors.lastname: Narisawa
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Aoyagi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000409:Alanine / Q000031:analogs & derivatives* / Q000494:pharmacology / Q000627:therapeutic use; D000897:Anti-Ulcer Agents / Q000494:pharmacology / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016145:Endoscopy, Digestive System / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005753:Gastric Mucosa / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D018919:Neovascularization, Physiologic / Q000187:drug effects; D011446:Prospective Studies; D054328:Proton Pump Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D015363:Quinolones / Q000494:pharmacology* / Q000627:therapeutic use*; D013274:Stomach Neoplasms / Q000601:surgery*; D013276:Stomach Ulcer / Q000188:drug therapy* / Q000209:etiology*; D013997:Time Factors; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects*
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D015363:Quinolones; C052785:rebamipide; D000409:Alanine