Background: Portal hypertensive gastropathy (PHG) is a cause of portal hypertensive related bleeding, for which no medications have been shown showed efficacious. In a recent molecular study in PHG rat model, rebamipide was noted to promote healing of damaged gastric mucosa. In the present study, we attempted to demonstrate this effect in PHG patients.Methods: From October 2009 to December 2009, patients undergoing esophagogastroscopy (EGD) at Maharaj Nakorn Chiang Mai Hospital who were found to have PHG were randomized to receive either rebamipide or placebo. After 12 weeks of treatment, follow up EGD and hemoglobin level were performed to compare endoscopic changes and hemoglobin levels within and between the two groups.Results: Eight patients were included in the study. Of the 4 patients in the rebamipide group, 1 patient showed an improvement in the PHG score, 2 patients were found to have a worsened PHG score, and 1 patient showed no change. In the placebo group, all 4 patients exhibited no change in the PHG score. No statistically significant changes in the PHG score were noted. Increased in hemoglobin levels after treatment were not statistically significant in the two groups (1.3 ±0.8 vs 1.4 ±1.2; p = 0.773).Conclusion: Rebamipide was not shown to exert a beneficial effect on PHG in this small pilot study.