Furuta R et al. (2007) Rebamipide enema therapy as a treatment for patients with active distal ulcerative colitis. J Gastroenterol Hepatol 22: 261–267

Furuta et al. have found that rebamipide enema therapy is safe and effective in patients with corticosteroid-refractory, active, distal ulcerative colitis. Corticosteroids are used to treat acute exacerbations of ulcerative colitis but prolonged treatment is associated with serious complications; the cytoprotective agent rebamipide was assessed because of its ability to promote mucosal healing.

In this prospective study, 20 patients (age range 18–74 years, 5 men) with active, distal ulcerative colitis who had received corticosteroids for >2 weeks without improvement (16 with left-sided colitis, 4 with pancolitis) were treated with rebamipide enemas twice a day for 3 weeks; patients also received prednisolone (20–40 mg daily) and 5-aminosalicylic acid (1.50–2.25 g daily). At 3 weeks, 16 patients (80%) were judged (by colonoscopy findings) to be responders, 11 (55%) of these had achieved clinical remission. No side effects were reported in any patient during the 3 week treatment period.

To assess immunological responses to rebamipide, rectal mucosal biopsies were obtained from patients before treatment and after 3 weeks. In responders (but not nonresponders), levels of the proinflammatory cytokine interleukin (IL)-1β had decreased by 3 weeks. Furthermore, imbalance in the ratio of IL-1 receptor antagonist:IL-1β, which is speculated to contribute to chronicity of intestinal inflammation, had improved in responders (but not nonresponders) after 3 weeks. In contrast to corticosteroid therapy, rebamipide treatment did not affect neutrophil infiltration. Indications that the mode of action of rebamipide might be distinct from that of corticosteroids hint at a complementary role for this therapy.