Comparative Efficacy and Safety of Stillen® and Rebamipide in Patients with Acute or Chronic Gastritis: A Systematic Review and Network Meta-Analysis of Randomized Controlled Trials

<b>Background</b>: Erosive gastritis has various causes, and severe damage to the mucosa can cause symptoms such as indigestion, abdominal pain, nausea, and vomiting. The condition is defined by visible erosions that emerge as discrete defects in the gastric mucosa. Stillen^® is a natural mucosal-protective agent derived from <i>Artemisia asiatica</i>, but its comparative efficacy versus rebamipide remains unclear. This systematic review and network meta-analysis evaluated whether Stillen^® leads to non-inferior endoscopic improvement outcomes compared to rebamipide in patients with acute or chronic gastritis. <b>Methods</b>: Databases including PubMed, EMBASE, Cochrane Library, RISS, KoreaMed, ClinicalTrials.gov, and ICTRP were searched through 15 August 2025. Eligible studies were randomized controlled trials (RCTs) comparing Stillen^® with rebamipide or other mucosal-protective agents in gastritis. Two reviewers independently screened studies, extracted data, and evaluated the risk of bias. The primary outcome was the improvement rate (≥50% erosion reduction); the secondary outcome was the cure rate (complete erosion resolution) and safety outcomes. <b>Results:</b> A total of 11 RCTs met the inclusion criteria, with 9 contributing to the primary network analysis. Stillen^® was non-inferior to rebamipide in terms of the improvement rate at 2 weeks (OR: 1.11, 95% CI: (0.88, 1.39) in FAS) and in pooled analysis across 2, 3, and 4 weeks. Cure rates showed no significant differences between the two agents. The safety outcomes were comparable, with no significant differences. Most studies were assessed as having a low risk of bias, and the certainty of evidence was rated as high for most efficacy outcomes. <b>Conclusions:</b> The network meta-analysis suggests that Stillen^® is non-inferior to rebamipide in improving erosions in patients with acute or chronic gastritis.