QUANTITATIVE AND QUALITATIVE USEFULNESS OF REBAMIPIDE IN ERADICATION REGIMEN OF HELICOBACTER-PYLORI

The aim of the present study was to determine the efficacy of a new co mbination regimen including antioxidant, proton pump inhibitor, and an tibiotics against Helicobacter pylori and to document the changes of o xidative stress and cytokines involved in H. pylori-associated gastrit is. From each of 57 patients with endoscopically diagnosed gastric and /or duodenal ulcers associated with H. pylori infection, five gastric antral biopsy specimens were taken for the diagnosis of H. pylori and for experimental measures. The patients were then treated either with lansoprozole 30 mg + amoxicillin 1.5 g (LB group; 21 patients) or lans oprazole 30 mg + amoxicillin 1.5 g + rebamipide 300 mg (LAM group; 36 patients) for two weeks. Four weeks after the initiation of treatment, the patients were endoscoped again and biopsy specimens were obtained . Mucosal malondialdehyde (MDA) levels; myeloperoxidase (MPO) activiti es; superoxide dismutase; catalase; glutathione peroxidase; cytokines IL-1, IL-6, TNF-alpha; and chemokines IL-8, GRO-alpha, RANTES (regulat ed on activation normal T expressed and secreted) were measured. Using paraffin-embedded tissue sections, ii situ terminal deoxyribonucleoti de transferase (TdT) -mediated dUTP nick end labeling (TUNEL) for apop tosis and immunohistochemical staining for inducible nitric oxide synt hase (iNOS) were performed. Two weeks of treatment with the LA regimen resulted in 57.4% eradication rates of H. pylori, whereas two weeks o f treatment with the LAM regimen resulted in 75.0% eradication rates. Eradication rates between these two groups were statistically signific antly different (P < 0.05). Mucosal MDA levels and MPO activities were significantly lower in the LAM group than the LA group. Mucosal level s of cytokines IL-1, IL-6, and TNF-alpha and of chemokines IL-8, GRO-a lpha, and RANTES were all significantly decreased after the treatment of H. pylori, especially in the LAM-treated group. The apoptotic index and iNOS score were significantly reduced after the eradication of H. pylori. The addition of the antioxidative drug rebamipide to the erad ication regimen against H. pylori has quantitative and qualitative adv antages such as either augmenting the eradication rates of H. pylori o r decreasing oxidative stress and cytokines levels generated by PI. py lori infection.