Review article: clinical significance of mucosal-protective agents: acid, inflammation, carcinogenesis and rebamipide.

While a great deal of clinical evidence has been found regarding anti-acids for the treatment of gastric disorders including peptic ulcers, not all disorders can be explained only by the hyperfunction of acid secretion. Especially in the Asian region, glandular atrophy is more prominent than in Western countries, therefore low acid output is often observed in these patients. Improvement of mucosal protection is rational therapy for these patients; this is the reason for use of these agents in Asian countries. Rebamipide has many biological activities for gastric mucosa such as increasing the blood flow and biosynthesis prostaglandins and the decrease of oxygen radicals. These suggest the possible efficacy of rebamipide in the prevention of both Helicobacter pylori-related and nonsteroidal anti-inflammatory drug (NSAID)-induced gastric injury, which has been proved by human studies. Rebamipide is the only mucosal-protective drug which can improve the histological gastritis in vivo, whereas anti-acids have a lesser effect in influencing gastritis. Improvement of gastritis is expressed not only in quantity but also in quality of gastritis, which is shown as the reduction of iNOS expression in the gastric mucosa. Clinically, it is suggested that rebamipide has the potential to prevent gastric carcinogenesis by improvement of histological gastritis.