Efficacy Of Sucralfate Research Articles

English

BACKGROUND Diabetic patients have reduced ability to metabolize glucose resulting in elevated blood sugar levels which further burdens the wound healing process. This leads to non-healing chronic ulcers. The sufferers of chronic diabetic foot ulcers are increasing globally due to lack of preventive and control measures. Sucralfate has been demonstrated in molecular studies to enhance the granulation tissue proliferation and thus promoting ulcer healing in the skin. Various clinical studies have also showed the efficacy of sucralfate in complete healing of the wound and in reducing the size of the wound. The purpose of this study was to compare the efficacy of topical sucralfate with that of povidone iodine dressing, in the healing of diabetic ulcers. METHODS This is a randomized comparative study. Among 100 patients, 50 patients received treatment in the form of povidone iodine dressings and 50 took treatment with sucralfate dressing. The patient underwent a detailed clinical examination. Relevant investigations were also done. The initial wound area was recorded after thorough debridement by measuring length x width. Both the groups underwent dressings once daily. The patients were followed up daily for a period of 3 weeks in both the groups. RESULTS In this study, the mean ± SD area of reduction of the ulcer was observed to be higher in sucralfate group 54.17 ± 10.08 than the povidone iodine group 16.07 ± 4.19. There was a statistically significant difference between the groups for the mean of area reduction (P < 0.0001, significant). CONCLUSIONS The ulcers in subjects treated with sucralfate dressing (S group) contracted more than the ulcers in the patients treated with povidone iodine (P group) (54.17 % Vs 16.07 %; P = < 0.0001, significant) which points out that sucralfate dressing is an effective modality in helping the reduction of wound area in patients with diabetic foot ulcers. KEYWORDS Diabetic, Sucralfate, Area of Reduction

Efficacy of Sucralfate in alleviation of postoperative morbidity after tonsillectomy.

Objectives: Despite of the therapeutic advancement, post-tonsillectomy pain is one of the most commonly observed morbidities associated with this surgical procedure which in turn highlights the need for appropriate analgesic consumption that assures safety and efficacy. Through this study our basic motive was to evaluate the sucralfate efficacy in the management of post-tonsillectomy symptoms during the first week of the surgery. Study Design: An Interventional, Quasi Experimental, (double-blind), purposive study. Setting: Department of Otorhinolaryngology and Head and Neck Surgery, Dow University of Health Sciences & Civil Hospital Karachi. Period: From January to June 2018. Material & Methods: One hundred and forty tonsillectomy patients of both genders between the age group of 7 to 35 years were randomly included in the study and categorized into 2 groups i.e. trial (Sucralfate group; Group A) and control (Pyodine group; Group B) with 70 patients in each group. The patients in group A were recommended to gargle with sucralfate suspension 4 times a day while following the same procedure except the group B interventional product was replaced with Pyodine mouth wash. The post-operative symptoms and secondary outcomes including pain, otalgia, odynophagia, analgesic requirements, slough shedding, bleeding and other associated side-effects were monitored. Pain, otalgia and odynophagia were assessed using the universal pain assessment tool (UPAT) while the secondary outcomes through a scoring system generated internally. Results: It is revealed from the study results that there was significant decrease in the throat pain and odynophagia in group A from 3rd to 7th post-tonsillectomy day (p < 0.05); while the results were not very significant for otalgia. The same could be applied for other secondary outcomes i.e. the analgesic requirement greatly decreased in patients given sucralfate presenting faster recovery. Moreover, early return to normal diet was observed for the patients treated with sucralfate. No serious adverse effects observed among the patients both groups. Conclusion: Sucralfate can be recommended as the first choice of treatment for the management of post-tonsillectomy symptoms on the basis of its efficiency in treating pain and other symptoms and hence providing maximum safety.

Efficacy of Sucralfate in Alleviating Pain And Morbidity in Post-Tonsillectomy Patients- A Randomized Control Trial

Efficacy of Sucralfate in Alleviating Pain And Morbidity in Post-Tonsillectomy Patients- A Randomized Control Trial

Efficacy of Sucralfate in Reflux Disease in comparison to H2 – Receptor Antagonist: A Meta-Analysis of Randomized Trials

Background and Aim: Reflux esophagitis is characterized by the erosions of esophagus due to gastric acids. H2-Recptor antagonists are considered as effective therapy. We compared sucralfate with H2-receptor antagonist for treatment of reflux esophagitis. Methods: Seven studies are selected from different databases (PUBMED, MEDLINE, COCHRANE LIBRARY, CINAHL etc.) comparing the treatment of sucralfate with H2-receptor antagonists (cimetidine and ranitidine). All studies selected are randomized controlled clinical trials. We applied inclusion and exclusion criteria for selection of studies. We also checked for heterogeneity and publication bias. We calculated odds ratio and 95% confidence interval for each study. We searched for national library of medicine’s clinical trial registry for any unpublished data. Results: Seven studies consisting of 319 patients finally selected for meta-analysis. We evaluated confidence interval and odds ratio for each study. None of the study show statistical significant result (p>0.05). The overall effect obtained by combining studies shows no statistical significant result (OR= 1.357, 95% CI=0.834 to 2.206, P-value=0.219, I2=0) between sucralfate and H2-recptor antagonist. There is no heterogeneity among the studies (I2=0, χ2 =4.8). Conclusion: We can conclude that sucralfate is an effective alternate for treatment of reflux disease.

Evaluating Sucralfate as a Phosphate Binder in Normal Cats and Cats with Chronic Kidney Disease

Control of hyperphosphatemia is an important part of the management of chronic kidney disease (CKD). The purpose of this study was to determine the efficacy of sucralfate as a phosphate binder in normal cats and normophosphatemic CKD cats. A 500 mg sucralfate slurry was administered orally q 8 hr for 2 wk, and serum phosphorus, urine fractional excretion of phosphorus, and fecal phosphorus concentrations were measured. In normal cats treated with sucralfate, significant changes in serum phosphorus concentration or urinary excretion of phosphorus were not detected, and vomiting occurred after 14.7% of administrations. Of the five normophosphatemic cats with CKD treated with sucralfate, three experienced clinical decompensation, including vomiting, anorexia, constipation, and increased azotemia. Administration of sucralfate did not result in significant changes in fecal phosphorus concentration in these cats. The effects of sucralfate administration on serum phosphorus concentration and urinary excretion of phosphorus in CKD cats was difficult to determine because of dehydration and worsening azotemia associated with decompensation. Due to side effects and the apparent lack of efficacy of the medication, the study was discontinued. This study was unable to confirm efficacy of this sucralfate formulation as a phosphate binder, and side effects were problematic during the study.

The efficacy of sucralfate combined with famotidine for acute gastritis in 120 patients

Objective To observe the efficacy of sucralfate combined with famotidine for acute gastritis in patients.Methods 120 patients with acute gastritis who had visited our department of digestive diseases were divided into a study group and a control group.The study group received combination therapy with sucralfate and famotidine,whereas the control group received famotidine alone.The efficacy was compared between the two groups.Results The effectiveness rate was obviously higher in the study group than in the control group,with a statistical difference (P＜0.05).Conclusions Sucralfate combined with famotidine has an ideal efficacy in the treatment of acute gastritis and is more effective than famotidine alone.This combination therapy has a value for further clinical popularization and application. Key words: Sucralfate; Famotidine; Combination therapy; Acute gastritis

Efficacy of Sucralfate in the Postoperative Management of Uvulopalatopharyngoplasty

To evaluate the effectiveness of sucralfate in influencing throat pain, otalgia, analgesic requirement, bleeding, mucosal recovery, and incidence of postoperative bleeding in patients undergoing uvulopalatopharyngoplasty. A prospective double-blind randomized study. University-affiliated tertiary referral hospital. Eighty adult patients with obstructive sleep apnea syndrome requiring uvulopalatopharyngoplasty were recruited and randomly allocated into either a sucralfate treatment group or a control group. All patients underwent uvulopalatopharyngoplasty. Patients enrolled in the sucralfate group (n=40) were instructed to gargle the sucralfate suspension and then to swallow. Patients enrolled in the control group (n=40) were instructed to gargle placebo suspension at the same doses and schedule. Postoperative throat pain, otalgia, amount of analgesic required, degree of strength (defined as patients' general well-being and return to regular daily activities), percentage of mucosal covering, and postoperative bleeding. Throat pain and otalgia occurred significantly less often in sucralfate group, with less analgesic requirement and with rapid mucosal healing and early return to regular daily activities. There was no significant difference in episodes of postoperative bleeding between the 2 groups (P=.37). Although sucralfate therapy may not provide complete analgesia after uvulopalatopharyngoplasty, it may reduce the amount of analgesic required, thus preventing dose-related adverse effects from the analgesic agent. It can also significantly reduce the total number of days needed to return to normal daily activities (P=.41).

Efficacy of sucralfate in eradication triple therapy for Helicobacter pylori infection as compared to a lansoprazole-based regimen

Efficacy of sucralfate in eradication triple therapy for Helicobacter pylori infection as compared to a lansoprazole-based regimen

Sucralfate for posttonsillectomy analgesia

Pain is one of the most troublesome complications of tonsillectomy. The pain appears as throat pain, otalgia, or both, and continues until mucosal recovery on the tonsillar fossae is complete. Some surgical and hemostasis techniques may increase pain. Analgesics, antibiotics, steroids, and local and topical anesthetics are used to relieve posttonsillectomy pain, but none has the desired effectiveness. The pain reliever must not increase bleeding and must have minimal side effects. Sucralfate, a basic amino salt of sucrose octasulfate, binds to the matrix protein of a peptic ulcer and produces a protective barrier. Tonsillectomy leaves two large ulcerous wounds, and sucralfate may bind those wounds as it does peptic ulcers. In this controlled study, the efficacy of sucralfate on posttonsillectomy throat pain, otalgia, analgesic requirement, degree of strength, bleeding, body temperature, and mucosal recovery is investigated in 80 patients. Sucralfate is found to significantly reduce throat pain and analgesic requirement after surgery. (Otolaryngol Head Neck Surg 1998;119:700-4.)

EFFICACY OF SUCRALFATE IN PREVENTING GASTROINTESTINAL SIDE EFFECTS OF NSAIDs

To find out the efficacy of sucralfate in preventing gastrointestinal side effects of non-steroidal anti-inflammatory drugs (NSAIDs) a prospective, randomised single blind study was conducted from 1989 to 1992. Patients with osteoarthritis, rheumatoid arthritis and other long standing painful conditions, who were expected to receive NSAIDs for over three months, were recruited into the study. All medicines were discontinued for a period of 10-15 days prior to initial endoscopic assessment. NSAID therapy was started and the patients were randomised to receive either placebo (group A) or sucralfate (group B) in addition. Patient were reassessed clinically every week and an endoscopic examination was repeated after 6-8 weeks of follow-up. A total of 176 patients were studied in group A (n=91) and group B (n=85). At the end of 8 weeks gastrointestinal symptoms were present in 30.6% and 26.4% patients of group A and B respectively. Endoscopic assessment showed superficial lesions in 36.5% and 18.7% while endoscopic ulcer in 2.4% and 1.1% patients of groups A and B respectively. Thus in patients receiving chronic NSAID therapy, simultaneous administration of sucralfate reduces the incidence of superficial gastric lesions but has no significant effect on symptoms or ulcer formation.

The therapeutic strategy for peptic ulcer disease

Therapy of acid/peptic disease has evolved since the 1970s with development of: (i) more accurate endoscopes which permit precise examination and documentation of upper gastrointestinal lesions; and (ii) the histamine H2-receptor antagonists. As well, refined standards for clinical investigation have contributed to the clinical study of acid/peptide diseases. Initially, ulcer diseases were considered to be principally secondary to increased 'aggressive' factors (acid, pepsin) and the therapeutic focus was directed at antacids, the progressive evolution of additional histamine H2-receptor antagonists and recently the H+/K(+)-ATPase inhibitors. Later studies indicated efficacy of sucralfate, low dose antacids and prostaglandin analogues, drugs with either no or only modest antisecretory effect. This led to studies on the role of gastroduodenal mucosal defensive factors (mucus and bicarbonate secretion, blood flow, leucocyte adherence, cytokines, reactive oxygen radicals). The prominent role played by aspirin and other non-steroidal anti-inflammatory drugs (NSAID) in initiating and causing recurrence of peptic ulcer disease has been increasingly realized. Recognition of those most at risk for NSAID-induced complication has led to newer approaches to treatment and prevention. Since 1983, Helicobacter pylori has been incriminated as a major factor in the pathogenesis of ulcer disease, particularly ulcer recurrences. Treatment of such ulcers now includes antibiotics and bismuth compounds in order to eradicate H. pylori. This therapeutic regimen is in a state of flux ('triple therapy' vs a H+/K(+)-ATPase inhibitor plus antibiotic) as is the question of how to work up and treat patients initially presenting with ulcer symptoms.

Clinical relevance of basic research in peptic ulcer disease

Historically, the interplay between basic research and clinical observation has been essential in the development of new therapies for peptic ulcer disease. That histamine is an important regulator of acid secretion emerged from basic research, followed by the clinical development and use of the H2-receptor antagonists. Basic research contributed again by defining the importance of H+/K(+)-ATPase in acid secretion, resulting in a new class of useful antisecretory agents. Basic studies also gave us prostaglandins (PG) as mucosal protective agents. As 'replacement' therapy, clinicians have found that PG are protective against non-steroidal anti-inflammatory drug (NSAID)-induced gastric ulcer (GU). Physiologic studies established that somatostatin is a potent inhibitor of acid secretion, providing the stimulus for clinical studies in Zollinger-Ellison (ZE) Syndrome with a synthetic analog (octreotide). Work on isoforms of the parietal cell gastrin receptor has shown differences in the cytoplasmic domain for G protein coupling. This will aid in understanding how receptor changes and coupling to second messengers relate to the aetiopathogenesis of abnormal gastric secretion. Immune cells express mRNA for histamine, muscarinic and gastrin receptors, supporting the relevance of mucosal immunology in gastroenterology, especially in light of Helicobacter pylori-associated gastritis and ulcers. Lab research has revealed a potential role for basic fibroblast growth factor (bFGF), and another endogenous peptide BPC-15, in ulcer healing. The former substance may be responsible for the antiulcer efficacy of sucralfate. Intensive basic work on how H. pylori organisms attach to gastric cells and initiate inflammatory reactions in the mucosa will have unquestionable impact on improved therapy for peptic ulcer disease.

Functional Dyspepsia

Symptoms of functional dyspepsia are frequent; the prevalence of dyspepsia (defined as pain or discomfort centred in the upper abdomen) in the general population approaches 25%. By definition, patients with functional dyspepsia do not have a structural or biochemical explanation for their symptoms. Disorders of function (e.g. delayed gastric emptying) are detectable in a proportion of patients but remain poorly understood. Nevertheless, the current rationale for drug treatment is based on altering pathophysiological mechanisms which are believed to be associated with the development of symptoms. Although the placebo response rates approach 60%, prokinetics, acid-suppressing agents and bismuth-containing compounds have been shown to be significantly better than placebo in reducing symptoms. Antacids are widely used, but no controlled study has been able to demonstrate a significant benefit over placebo. The efficacy of sucralfate is uncertain. Rational guidelines on which drug should be used for a given patient are lacking, although approaches based on symptom profiles have been proposed; the duration of treatment needed to achieve long-lasting relief of symptoms is also poorly defined. Identifying optimal treatment for the individual patient, therefore, continues to be largely a trial and error process. Further research efforts are needed to elucidate the pathophysiological basis of functional dyspepsia so that specific therapy can be tailored to underlying pathophysiological disturbances.

Stress Bleeding Prophylaxis with Sucralfate: Pathophysiologic Basis and Clinical Use

The development of acute stress bleeding in intensive-care patients occurs on a multifactorial basis. The basic mechanism lies in the imbalance between aggressive and protective factors. Most intensive care patients show a reduced acid secretion, a reduction of the gastric mucosal blood flow, and a decreased mucus and bicarbonate secretion. Sucralfate enhances most of the defensive mechanisms. These actions are the pathophysiologic basis of the efficacy of sucralfate in the prevention of stress bleeding. Because sucralfate has only a minor influence on the gastric pH and at the same time has proven bactericidal effects, gastric and gut bacterial overgrowth is significantly reduced. These effects explain the observed differences in mortality between sucralfate and alkalinizing drugs like antacids or H2-antagonists. The indications and limits of sucralfate in stress bleeding prophylaxis are pointed out.

Sucralfate maintenance therapy in duodenal ulcer disease: A review

There are a large number of patients with chronic duodenal ulcer disease who warrant long-term maintenance therapy to diminish the risk of recurrence and there by the risk of further complications such as gastrointestinal bleeding. The efficacy of sucralfate has been compared with both placebo and histamine (H 2)-receptor antagonists and sucralfate in a dose of 1 g twice a day or 2 g taken at night. It is a safe and effective medication in preventing duodenal ulcer recurrence. However, duodenal ulcer relapse rates always exceed 20 percent and frequently approach 50 percent, whether the therapy be H 2-receptor antagonists or sucralfate, and the use of dosages that are half the healing dose seems irrational. It would therefore seem reasonable to continue maintenance therapy at the healing dose, whatever medication is used. Any increased costs for drugs should be outweighed by savings in indirect costs.

Sucralfate for the Prevention of Early Rebleeding Following Injection Sclerotherapy for Esophageal Varices

One hundred and eighty patients with variceal bleeding and treated by long-term sclerotherapy were randomized into a prospective randomized controlled clinical trial to assess the efficacy of sucralfate to reduce the frequency of rebleeding prior to variceal obliteration. Overall 29 (32%) of the 92 patients treated with the addition of sucralfate rebled compared to 37 (42%) of 88 managed by sclerotherapy alone (p < 0.10). Considering patients widi well-compensated liver disease only 14 (24%) of 59 receiving sucralfate rebled compared to 25 (42%) of 60 in the sclerotherapy alone group (p < 0.05). The frequency (∼ 70%), number and extent of sclerotherapy-induced esophageal mucosal ulceration was not different for the two groups, however rebleeding from this site occurred less frequently in those treated bv sucralfate (10 and 20 occasions respectively, p < 0.05). Mortality was not different for the two groups. In this trial sucralfate has been shown to reduce the frequency of rebleeding during long-term trea...

Efficacy of sucralfate and cimetidine in protection of the human gastric mucosa against alcohol injury

In order to study whether sucralfate or cimetidine may protect human gastric mucosa against alcohol injury, 28 healthy volunteers were pretreated with either: (1) placebo 1 g; (2) cimetidine (Tagamet) 300 mg; or (3) sucralfate (Carafate) 1 g. One hour later, 100 ml of 40 percent ethanol was sprayed directly on the gastric mucosa of the greater curvature during an endoscopic examination. Gastric mucosal changes were assessed by endoscopic appearance (according to grading scale) and by histology. In placebo-pretreated subjects, alcohol produced prominent mucosal damage (endoscopic score, 3.9 ± 0.3, histologic score, 4.0 ± 1.1 at 30 minutes). Cimetidine alkalinized gastric pH but did not prevent alcohol-induced damage (endoscopic score, 4.0 ± 0.6; histologic score, 3.8 ± 1.1, at 30 minutes). Sucralfate reduced endoscopic and histologic features of alcohol injury (endoscopic score, 1.8 ± 0.6; histologic score, 1.8 ± 1.1, at 30 minutes) without affecting gastric luminal pH. Reduction of alcohol-induced injury of the human gastric mucosa by sucralfate but not cimetidine demonstrates that effective protection of the gastric mucosa can be achieved without neutralization or inhibition of gastric acid secretion and points out another clinical application for sucralfate.

Effects of sucralfate, 15(R)15-methyl prostaglandin E 2, and cimetidine on rat gastric mucosal damage induced by ethanol

The efficacy of sucralfate, 15(R)15-methyl prostaglandin E 2, and cimetidine in protecting against ethanol injury in rat stomachs was examined. Rats that had been fasted were pretreated intragastrically with either sucralfate 160 mg/kg, 15(R)15-methyl prostaglandin E 216 μg/kg, cimetidine 100 mg/kg, or an equal amount of vehicle alone (control). One hour later, all rats received 1 ml of 99.5 percent ethanol orally and were killed 15 minutes or 24 hours later. Stomachs were removed, and mucosal damage was assessed macroscopically as well as by scanning electron microscopy. Pretreatment with either 15(R)15-methyl prostaglandin E 2 or sucralfate significantly reduced the number and extent of ethanol-induced mucosal gastric lesions; pretreatment with cimetidine, however, failed to produce positive results. It is concluded that the abilities of 15(R)15-methyl prostaglandin E 2 and sucralfate in protecting against ethanol injury are comparable.

Medical and Surgical Prophylaxis for Duodenal Ulcer, the Role of Sucralfate

The risk of recurrent duodenal ulcer is high, 70-80% of duodenal ulcer patients having a recurrence during the first year after initial healing. Surgery has so far been the main method for preventing a relapse, but recent studies have shown that it is possible to reduce the risk and the need for surgery with medical maintenance therapy. Five controlled studies are available on the efficacy of sucralfate in prophylaxis for duodenal ulcer. 294 patients participated, 154 having received sucralfate treatment, usually 1 g twice daily. The summarized results indicate that initially healed duodenal ulcers recurred in six months in 60% of cases and in 12 months in 79% of cases in groups receiving placebo therapy or no treatment, the corresponding figures in the groups treated with sucralfate being 21% and 31%. The choice between surgical and medical prophylaxis is discussed, and more liberal use of medical prophylaxis is advocated.

Sucralfate. A review of its pharmacodynamic properties and therapeutic use in peptic ulcer disease.

Sucralfate is a basic aluminium salt of sulphated sucrose which is advocated for use in peptic ulcer disease. It is minimally absorbed after oral administration and is believed to act primarily at the ulcer site by protecting the ulcer from the effects of pepsin, acid and possibly bile salts. Controlled therapeutic trials have demonstrated that sucralfate 1g 4 times daily is effective in increasing the rate of healing of duodenal and gastric ulcer over a period of 4 to 8 weeks. Trials comparing sucralfate and cimetidine have not found any significant difference in efficacy between the drugs in small numbers of patients. A dosage of 2g daily given prophylactically decreases the rate of recurrence of duodenal ulcers, but the efficacy of sucralfate in preventing relapse of gastric ulcers has yet to be clearly demonstrated. Sucralfate is particularly well tolerated. Constipation, the most common side effect, occurs in 2% of patients. Thus, sucralfate offers an effective and well tolerated alternative for the management of peptic ulcer disease.