title: Efficacy and safety of proton pump inhibitors (PPIs) plus rebamipide for endoscopic submucosal dissection-induced ulcers: a meta-analysis.
abstract: OBJECTIVE
  To compare the efficacy of proton pump inhibitors (PPIs) with rebamipide versus PPIs alone for the treatment of ulcers after endoscopic submucosal dissection (ESD).
  
  
  METHODS
  PubMed, Web of Science, Medline, Embase, the Cochrane Central Register of Controlled Trials and China Naitonal Knowledge Infrastructure were searched up to the end of October 2013 in order to identify all randomized controlled trials reporting the effects of PPIs plus rebamipide on healing ulcers after ESD. The outcome measurement was complete ulcer healing.
  
  
  RESULTS
  A total of six studies involving 724 patients were included. The pooled data suggested a significantly higher rate of ulcer healing after endoscopic therapy among patients treated with PPIs plus rebamipide than among those treated with PPIs alone [odds ratio (OR)=2.40, 95% confidence interval (CI): 1.68-3.44]. The subgroup analysis showed PPI plus rebamipide therapy to be more effective in healing ESD-induced ulcers than treatment with PPIs alone after both four (OR=2.22, 95%CI: 1.53-3.24) and eight weeks of treatment (OR=3.19, 95%CI: 1.22-8.31). In addition, the combination therapy was found to be significantly more effective than the use of PPIs alone for all ESD ulcers greater than 20 mm in size (OR=4.77, 95%CI: 2.22-10.26). There were no significant differences between the treatment groups with regard to ulcer location (low, middle or upper stomach) or the presence of absence of H. pylori infection. No serious adverse events were observed in either group.
  
  
  CONCLUSIONS
  The results of this meta-analysis suggest that treatment with PPIs plus rebamipide is superior to PPI monotherapy for healing ESD-induced ulcers over four weeks, particularly large ulcers. However, more well-designed trials are needed to confirm these findings.
authors.affiliation: Department of Gastroenterology, Renmin Hospital of Wuhan University, China.
authors.forename: Jun
authors.initials: J
authors.lastname: Wang
authors.forename: Xufeng
authors.initials: X
authors.lastname: Guo
authors.forename: Chuncui
authors.initials: C
authors.lastname: Ye
authors.forename: Shijie
authors.initials: S
authors.lastname: Yu
authors.forename: Jixiang
authors.initials: J
authors.lastname: Zhang
authors.forename: Jia
authors.initials: J
authors.lastname: Song
authors.forename: Zhuo
authors.initials: Z
authors.lastname: Cao
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Min
authors.initials: M
authors.lastname: Liu
authors.forename: Weiguo
authors.initials: W
authors.lastname: Dong
mesh_terms: D000409:Alanine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D000897:Anti-Ulcer Agents / Q000008:administration & dosage*; D004210:Dissection / Q000009:adverse effects*; D004359:Drug Therapy, Combination; D004724:Endoscopy / Q000009:adverse effects; D006801:Humans; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D015363:Quinolones / Q000008:administration & dosage*; D016032:Randomized Controlled Trials as Topic; D013276:Stomach Ulcer / Q000188:drug therapy* / Q000209:etiology*
chemical_list: D000897:Anti-Ulcer Agents; D054328:Proton Pump Inhibitors; D015363:Quinolones; C052785:rebamipide; D000409:Alanine