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Efficacy of Rebamipide in Organic and Functional Dyspepsia: A Systematic Review and Meta-Analysis

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Abstract

Objective

The role of gastritis in dyspepsia remains controversial. We aimed to examine the efficacy of rebamipide, a gastric mucosal protective agent, in both organic and functional dyspepsia.

Design

A systematic review and meta-analysis was performed. The following databases were searched using the keywords (“rebamipide” OR “gastroprotective agent*” OR “mucosta”) AND (“dyspepsia” OR “indigestion” OR “gastrointestinal symptoms”): PubMed, Wed of Science, Embase, CINAHL, Cochrane Clinical Trials Register. The primary outcome was dyspepsia or upper GI symptom score improvement. Pooled analysis of the main outcome data were presented as risk ratio (RR) for dichotomous data and standardized mean difference (SMD) for continuous data.

Results

From an initial 248 records, 17 randomised controlled trial (RCT) publications involving 2170 subjects (1224 rebamipide, 946 placebo/control) were included in the final analysis. Twelve RCTs were conducted in subjects with organic dyspepsia (peptic ulcer disease, reflux esophagitis or NSAID-induced gastropathy) and five RCTs were conducted in patients with functional dyspepsia (FD). Overall, dyspepsia symptom improvement was significantly better with rebamipide compared to placebo/control drug (RR 0.77, 95% CI = 0.64–0.93; SMD −0.46, 95% CI = −0.83 to −0.09). Significant symptom improvement was observed both in pooled RR and SMD in subjects with organic dyspepsia (RR 0.72, 95% CI = 0.61–0.86; SMD −0.23, 95% CI = −0.4 to −0.07), while symptom improvement in FD was observed in pooled SMD but not RR (SMD −0.62, 95% CI = −1.16 to −0.08; RR 1.01, 95% CI = 0.71–1.45).

Conclusion

Rebamipide is effective in organic dyspepsia and may improve symptoms in functional dyspepsia.

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Acknowledgments

MPT was a recipient of a University of Malaya Grand Challenge fund which also funded the salary of MHJ (GC002-14HTM).

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Authors and Affiliations

  1. Department of Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia

    Mohamed Hasif Jaafar, Sher Zaman Safi, Maw-Pin Tan & Sanjiv Mahadeva

  2. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia

    Sanjay Rampal

  3. Interdisciplinary Research Center in Biomedical Materials (IRCBM), COMSATS Institute of Information Technology, Lahore, Pakistan

    Sher Zaman Safi

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  1. Mohamed Hasif Jaafar
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Contributions

SM planned the study, contributed to data collection, and drafted the manuscript. MHJ and SZS performed data collection and preliminary data analysis. MPT planned the study and performed data collection. SR performed final data analysis and contributed to the drafting of the manuscript. All authors agreed on the final draft of the manuscript.

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Correspondence to Sanjiv Mahadeva.

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The authors declared that they have no conflicts of interest.

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Fig. 6

Funnel plot demonstrating pooled analysis for RCT studies with continuous outcomes for dyspepsia based on symptom duration ≤ 4 weeks and > 4 weeks (JPEG 111 kb)

Fig. 7

Funnel plot demonstrating pooled analysis for RCT studies with categorical outcomes for dyspepsia based on various UGI symptom scales (JPEG 135 kb)

Fig. 8

Funnel plot demonstrating pooled analysis for RCT studies with categorical outcomes for dyspepsia based on placebo compared with active drug control (JPEG 109 kb)

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Jaafar, M.H., Safi, S.Z., Tan, MP. et al. Efficacy of Rebamipide in Organic and Functional Dyspepsia: A Systematic Review and Meta-Analysis. Dig Dis Sci 63, 1250–1260 (2018). https://doi.org/10.1007/s10620-017-4871-9

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  • DOI: https://doi.org/10.1007/s10620-017-4871-9

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