Division of Gastroenterology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Research Institute for Future Medicine, Samsung Medical Center, Seoul, Korea.
Gut Liver. 2024 Nov 15;18(6):1026-1036. doi: 10.5009/gnl230372. Epub 2024 Mar 12.
BACKGROUND/AIMS: : The effect of proton pump inhibitors (PPIs) on the lower gastrointestinal (GI) tract is uncertain, with potential to worsen damage. This study aimed to find the best method for protecting the entire GI tract from mucosal damage.
: A retrospective cohort study at Samsung Medical Center (2002-2019) included 195,817 patients prescribed GI mucosa-damaging agents. The primary goal was to assess the effectiveness of GI protective agents in preventing significant hemoglobin drops (>2 g/dL), indicating overall GI mucosal damage. Self-controlled case series and landmark analysis were used to address biases in real-world data.
: The incidence rate ratios for rebamipide, PPI, and histamine-2 receptor antagonist (H2RA) were 0.34, 0.33, and 0.52, respectively. Rebamipide showed a significantly lower incidence rate than H2RA and was comparable to PPIs. Landmark analysis revealed significant reductions in hemoglobin drop risk with rebamipide and H2RA, but not with PPI.
: Rebamipide, like PPIs, was highly effective in preventing blood hemoglobin level decreases, as shown in real-world data. Rebamipide could be a comprehensive strategy for protecting the entire GI tract, especially when considering PPIs' potential side effects on the lower GI tract.
背景/目的：质子泵抑制剂（PPIs）对下胃肠道（GI）的影响尚不确定，可能会加重损伤。本研究旨在寻找保护整个胃肠道免受黏膜损伤的最佳方法。
在三星医疗中心（2002-2019 年）进行的回顾性队列研究纳入了 195817 名服用胃肠道黏膜损伤药物的患者。主要目标是评估胃肠道保护剂预防血红蛋白显著下降（>2g/dL）的效果，血红蛋白下降提示整个胃肠道黏膜损伤。采用自身对照病例系列和 landmark 分析来解决真实世界数据中的偏倚问题。
瑞巴派特、PPI 和 H2RA 的发生率比分别为 0.34、0.33 和 0.52。瑞巴派特的发生率明显低于 H2RA，与 PPI 相当。landmark 分析显示，瑞巴派特和 H2RA 可显著降低血红蛋白下降的风险，但 PPI 无此作用。
瑞巴派特与 PPI 一样，在真实世界数据中对预防血血红蛋白水平下降非常有效。瑞巴派特可能是一种全面保护整个胃肠道的策略，特别是在考虑到 PPI 对下胃肠道的潜在副作用时。
