A Role for Pre-Polymerized Sucralfate in the Management of Erosive and Non-Erosive Gastroesophageal Reflux Disease

Mccullough Ricky Wayne

doi:10.23937/2469-584x/1510072

Abstract

A Role for Pre-Polymerized Sucralfate in the Management of Erosive and Non-Erosive Gastroesophageal Reflux Disease

Highlights

The superior performance of acid-controlling therapies, namely proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA), eroded the early but tenuous role of sucralfate in the treatment of gastroesophageal reflux disease (GERD), which role had resulted from off-labeled use of sucralfate’s original prescription indication for duodenal ulcers
There were two notable exceptions - a trial conducted by Simon, et al [5] in NERD patients using a mucoadherent gel formulation of sucralfate (twice as potent as sucralfate suspension in terms of retention within gastrointestinal (GI) tract [6,7] and a trial conducted by Vermieidien, et al [8] using sucralfate suspension for eGERD
In the former study [5], a 14 mg/kg dose of sucralfate gel (1 gram) given twice daily for 42 days resulted in symptom relief for 71% of NERD patients compared to 29% on placebo

Summary

Introduction

The superior performance of acid-controlling therapies, namely proton pump inhibitors (PPI) and histamine-2 receptor antagonists (H2RA), eroded the early but tenuous role of sucralfate in the treatment of gastroesophageal reflux disease (GERD), which role had resulted from off-labeled use (mission creep) of sucralfate’s original prescription indication for duodenal ulcers. Observations that both pH-responsive and pH- non-responsive NERD patients exhibit dilated intercellular spaces in the esophageal epithelium [22] and basal cell hyperplasia beyond that of controls [23], suggest that mucosal reaction in functional and classic NERD is not a problem of acid content (pH) of gastric refluxate. Because near immediate mucosal reactions occur (epithelial regeneration, mucus secretion, prostaglandin release etc) when large concentrations of dissolving sucralfate adhere to the mucosa, some researchers have asserted that clinical effects of sucralfate emanate from its molecular engagement of growth factors expressed on enteric epithelium [89].

Lamina Propria and Submucosa

Findings

Conclusion