Comparing The Efficacy And Safety Of Rebamipide Versus Bismuth For H.pylori Eradication

Objective:Comparing the efficacy and safety of rebamipide quadruple therapy and bismuth quadruple therapy in the eradication of Helicobacter pylori(H.pylori),and to explore gastric mucosal protective agents that can replace bismuth in eradication therapy.Methods:H.pylori-positive patients who attended the gastroenterology outpatient clinic of the First Hospital of Shanxi Medical University from September 2021 to August 2022 were included.All patients were randomly divided into the rebamipide group and the bismuth group.The basic data of gender,age and somking of the two groups were compared,and the differences were not statistically significant(P>0.05),and were comparable.In the rebamipide group,patients were assigned to receive rabeprazole sodium enteric-coated capsule,rebamipide,clarithromycin,amoxicillin capsule for 14days.In the bismuth group,patients received rabeprazole sodium enteric-coated capsule,colloidal bismuth tartrate capsules,clarithromycin,amoxicillin capsule for 14days.The regimen of both groups was14 days,and the treatment effect was assessed by urea breath test after 4 weeks of discontinuation,the symptoms and relief were recorded before and after treatment,as well as whether side effects occurred.Results:A total of 90 patients were included,and 45 patients in each group,of which 43 patients were finally completed in the rebamipide group,and 41 patients were completed in the bismuth group.The intention-to-treat(ITT)analysis indicated that the eradication rates of the rebamipide group and the bismuth group were 88.4%and 82.2%,respectively,with no statistically significant difference(χ~2=0.080,P=0.777).The per-protocol(PP)analysis showed that the eradication rates of rebamipide group and bismuth group were 88.4%and90.2%respectively,and there was no statistically significant difference(χ~2=0.000, P=1.000).There was no statistical difference in the relief of symptoms between the two groups after treatment(P>0.05).The overall incidence of adverse reactions was lower in the rebamipide group than bismuth group(χ~2=4.865,P=0.027),but the difference in the incidence of each adverse reaction was not statistically significant(P>0.05),and all relieved after discontinuation of the therapy without serious adverse reactions.Adherence was 95.6%and 91.1%in the rebamipide and bismuth group respectively,with no statistically significant differences(χ~2=0.179,P=0.673).The C/E was 2.25 in the rebamipide group and 1.73 in the bismuth group.Conclusion:The efficacy of rebamipide quadruple regimen is comparable to that of bismuth quadruple regimen for H.pylori eradication,but the safety of rebamipide regimen is better.Rebamipide is expected to be a gastric mucosal protective agent that can replace bismuth for H.pylori eradication.