Is rebamipide enema in treating left-sided ischemic colitis with ulcer effctive?

According to Reeders et al, ischemic colitis involves the left colon in 75% of the cases and the right colon in 8%. While surgery is indicated for the treatment of the gangrenous type of ischemic colitis, many patients with the transient or stricture type of the disease improve with bowel rest by fasting and parenteral fluid administration alone. However, healing is frequently delayed in patients with ulcerative lesions. Recently, the efficacy of rebamipide enema in the treatment of ulcerative colitis has been reported in Japan.

The research team led by Prof. Satohiro Matsumoto from Kamigoto Hospital evaluated the therapeutic effects of rebamipide solution administered as an enema in ischemic colitis patients with ulcerative lesions. And this will be published on 7 July 2008, in the World Journal of Gastroenterology addresses this question.

They found that the mean fasting period and mean duration of hospitalization were 2.7 ± 1.8 day and 9.2 ± 1.5 day, respectively, in the rebamipide enema therapy group, as compared with 7.9 ± 4.1d and 17.9 ± 6.8 d, respectively, in the conventional therapy group; both the fasting period (P = 0.0121) and the duration of hospitalization (P = 0.0092) were significantly shorter in the rebamipide enema therapy group. As for the degree of ulcer healing, the ulcer score was reduced by 3.5 ± 0.5 (points) in the rebamipide enema therapy group and 2.8 ± 0.5 (points) in the conventional therapy group (P = 0.0797), with the interval between the baseline and follow-up examinations being 6.5 ± 0.8 d and 7.7 ± 2.7 d, respectively (P = 0.3293). The WBC count was decreased by 12.0 ± 5.6 (x 103/μL) in the rebamipide enema therapy group and 8.6 ± 5.7 (x 103/μL) in the conventional therapy group (P = 0.3360), with the interval between the baseline and follow-up examinations of 5.8 ± 1.7 d and 5.4 ± 1.5 d, respectively (P = 0.7515). Thus, both the degree of ulcer healing and the decrease in WBC count tended to be favorable in the rebamipide enema therapy group than in the conventional therapy group, but there was no significant difference in either parameter between the two groups.

Previous finding indicated that the duration of fasting and hospitalization were significantly prolonged in ischemic colitis patients with ulcer. A longer fasting period and longer duration of hospitalization pose problems, including stress associated with fasting and a high cost of long-term hospitalization.

Since the prevalence of atherosclerotic diseases may be expected to increase further with the accelerated aging of population, increase in the incidence of ischemic colitis is also inevitable. Authors sought suitable treatment methods to shorten these parameters. In this study, they evaluated the effects of rebamipide enema therapy in these patients. Rebamipide is an anti-ulcer drug used to treat peptic ulcer, which has been demonstrated to enhance the production of endogenous prostaglandin E2 via COX-2 and thereby act as a gastric mucosal protectant, to promote mucin production, and to suppress the production of free radicals, such as hydroxyl radicals and superoxide ions. The mechanism underlying the efficacy of rebamipide in the treatment of ischemic colitis remains unclear; however, it is assumed that the effect of the drug in suppressing free radical production and accelerating ulcer healing account for its efficacy in patients of ischemic colitis with ulcerative lesions. They recommend rebamipide enema therapy in left-sided ischemic colitis patients with ulcerative lesions.

Reference: Matsumoto S, Tsuji K, Shirahama S. Rebamipide enema therapy for left-sided ischemic colitis patients accompanied by ulcer: Open label study. World J Gastroenterol 2008; 14(25): 4059-4064
http://www.wjgnet.com/1007-9327/14/4059.asp

Correspondence to: Satohiro Matsumoto, MD, Department of Internal Medicine, Kamigoto Hospital, 1549-11 Aokata-gou, Shinkamigoto-cho, Minamimatsuura-gun, Nagasaki 857-4404, Japan. hiyo-mana@gol.com
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