Rebamipide for the Improvement of Gastric Atrophy and Intestinal Metaplasia: A Prospective, Randomized, Pilot Study

Dig Dis Sci. 2022 Jun;67(6):2395-2402. doi: 10.1007/s10620-021-07038-7. Epub 2021 May 30.


Background: The presence of atrophic gastritis (AG) and intestinal metaplasia (IM) is associated with an increased risk of gastric cancer (GC). Thus, the development of new strategies to improve AG/IM is essential for reducing the incidence of GC.

Aims: We aimed to evaluate the efficacy of rebamipide for improving AG/IM.

Methods: This was a prospective, randomized, pilot study from a single tertiary referral center. Fifty-three (rebamipide, n = 34 vs. placebo, n = 19) patients, who underwent endoscopic resection for gastric dysplasia or early GC, were analyzed. We obtained tissue samples from the antrum and corpus of the stomach, at the time of screening and 1-year later. The histologic grading of inflammation was performed by histopathologists RESULTS: The AG grade in the antrum improved significantly after rebamipide treatment (pre-administration, 1.870 ± 0.932 vs. post-administration, 1.430 ± 0.986; P = 0.013). Additionally, the severity of IM in the antrum was significantly improved (pre-administration, 1.750 ± 0.963 vs. post-administration, 1.370 ± 1.032; P = 0.038). The rebamipide subgroup analysis revealed that patients with no Helicobacter pylori (HP) infection showed significant improvements in AG in the antrum (pre-administration, 1.880 ± 1.040 vs. post-administration, 1.250 ± 0.894; P = 0.028) and IM in antrum (pre-administration, 1.840 ± 1.012 vs. post-administration, 1.180 ± 0.912; P = 0.020).

Conclusions: This study demonstrated that the administration of rebamipide improves AG and IM in the antrum, especially in patients with HP non-infection (KCT0001915).

Keywords: Atrophic gastritis; Gastric cancer; Histology; Intestinal metaplasia; Rebamipide.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Alanine / analogs & derivatives
  • Atrophy
  • Gastric Mucosa / pathology
  • Gastritis, Atrophic* / complications
  • Helicobacter Infections* / complications
  • Helicobacter Infections* / drug therapy
  • Helicobacter Infections* / epidemiology
  • Helicobacter pylori*
  • Humans
  • Metaplasia / pathology
  • Pilot Projects
  • Prospective Studies
  • Quinolones
  • Stomach Neoplasms* / complications


  • Quinolones
  • rebamipide
  • Alanine