Rebamipide is Not Indicated for Positive FIT Management
Colonoscopy, not rebamipide, is the mandatory next step for any patient with a positive fecal immunochemical test. The question fundamentally misunderstands the clinical pathway for positive FIT results.
Why Rebamipide is Irrelevant Here
- A positive FIT test requires colonoscopy as the definitive follow-up evaluation, with strong evidence supporting this approach from the U.S. Multi-Society Task Force on Colorectal Cancer 1, 2
- Rebamipide is a mucoprotective agent used for treating erosive gastritis and peptic ulcers, typically administered at 100 mg three times daily for 2-8 weeks depending on the indication 3, 4, 5
- There is no evidence or clinical rationale for using rebamipide to treat a positive FIT result, as FIT positivity indicates potential colorectal neoplasia requiring direct visualization and tissue diagnosis 6, 2
The Correct Management Pathway
- Schedule colonoscopy within 3 months of the positive FIT result, with a maximum acceptable delay of 6 months 1, 6, 2
- Healthcare systems should aim for ≥95% of follow-up colonoscopies to be performed within 6 months, with at least 80% offered an appointment within 3 months 1, 2
- Delays beyond 6 months are associated with increased risk of advanced adenomas, colorectal cancer, and advanced-stage disease 1, 6, 2
Critical Pitfall to Avoid
- Do not substitute any medical therapy (including rebamipide) for colonoscopy when FIT is positive 6, 2
- Do not repeat FIT instead of proceeding to colonoscopy, as colonoscopy is mandatory when the test is positive 6
- The positive predictive value for significant neoplasia with a positive FIT ranges from 40-47% for advanced neoplasia, making colonoscopy essential regardless of symptoms 6, 2
If Rebamipide Were Actually Indicated
For completeness, when rebamipide is appropriately used for gastritis or peptic ulcers: