Treatment of peptic ulcer disease with sucralfate: a review

Article Abstract:

Numerous studies have shown that sucralfate is an effective medication for the promotion of healing of stomach and duodenal ulcers. These studies indicate that from 60 to 90 percent of ulcers heal during treatment with this anti-ulcer drug. It is not clear which of sucralfate's physiological effects is responsible for the healing, but it seems likely that a large part of the benefit comes from strengthening the protective mucus barrier lining the stomach. Some other anti-ulcer drugs, such as ranitidine, work by reducing the secretion of stomach acid. When sucralfate is compared with ranitidine for the treatment of ulcers, it appears that ranitidine may result in a faster response. The published healing rates indicate that 75 percent of ulcers are healed after 4 weeks of sucralfate treatment, while 85 percent may be healed after the same duration of ranitidine treatment. However, by eight weeks the majority of ulcers are healed in both groups, and there are no apparent differences between the two treatments. Unfortunately, there have been fewer studies addressing the problem of ulcer relapse, and many have enrolled too few patients for conclusive results. Nevertheless, there is some evidence that, while sucralfate and ranitidine may be similar for healing ulcers, sucralfate may be superior for the delay of recurrence. This may be due to a rebound effect. Ranitidine is a member of a class of drugs called H2 blockers; these drugs block the type 2 histamine receptors. One effect of the H2 blockers is reduction of the secretion of stomach acid by the parietal cells in the stomach. However, there is some evidence that the parietal cells get used to the presence of ranitidine or other H2 blocker. When the drug is removed, these cells begin to secrete copious amounts of stomach acid, far more than they did before treatment. It is believed that this increase in stomach acid secretion may be responsible for the faster recurrence of ulcers in some patients treated with ranitidine, compared with those who receive sucralfate. (Consumer Summary produced by Reliance Medical Information, Inc.)

Complications and side effects

---

Longer relapse-free period after sucralfate than after H2-blocker treatment of duodenal and gastric ulcers

Article Abstract:

Unfortunately, although peptic ulcers can be effectively treated, they are very likely to recur at some point. Many studies on the recurrence of ulcers after treatment focus on the recurrence 'rate'. Most often this is given as a percentage; for example, 'at 12 months 30 percent of the patients had experienced recurrences'. However, this rate says nothing about the period of time which the patient spent free of ulcer. If one patient relapsed after three months and another after 10, it is clear that the second patient was far better off, despite the fact that both relapsed. For this reason, a study was conducted to compare not only the effectiveness of several ulcer treatments, but also the interval of time during which the patients were free from ulcers. The study compared H2 blockers, which reduce the secretion of stomach acid, with sucralfate, a medication that seems to fortify the protective mucus layer of the stomach. A total of 2,045 patients were identified who had relapsed after receiving H2 blockers. These patients were given sucralfate therapy and the interval of time to their next relapse was compared with the records indicating the time to relapse for their previous treatment with H2 blockers. The ulcer-free interval was longer with sucralfate treatment than with H2-blocker treatment for 73 percent of the patients. This was mirrored in the average duration of freedom from ulcer, which was 132 days for the H2-blocker treatment and 212 days for the sucralfate treatment. It is worth noting that 23 percent of the sucralfate-treated patients had not yet developed a recurrent ulcer at the time this one-year study ended. Analysis of the data revealed that the benefits were especially strong for elderly patients, patients who did not smoke, and patients who were experiencing their first relapse. (Consumer Summary produced by Reliance Medical Information, Inc.)

Antiulcer agents, Antiulcer drugs

---

Comparison of sucralfate and ranitidine in the treatment of duodenal ulcers

Article Abstract:

The drugs sucralfate and ranitidine are used in the treatment of peptic ulcers. The two compounds work in entirely different ways, however. Ranitidine is a so-called H2-receptor antagonist; it works by inhibiting the type 2 histamine receptors. The net result of this inhibition is a significant decrease in the secretion of stomach acid. In contrast, sucralfate has no effect on the secretion of stomach acid. Indeed, there is some indication that the presence of acid is important to the function of sucralfate. Although the precise mechanisms of sucralfate action are not certain, at least some of the benefit from this drug comes from its ability to bind to a stomach ulcer and promote the naturally protective mucus barrier. A study was conducted to compare treatment with ranitidine and sucralfate in 90 patients with duodenal ulcers, that is, ulcers in the duodenum, the first portion of small intestine (beyond the stomach) where much digestion takes place. In all cases, the ulcers were confirmed by direct viewing with the fiber-optic endoscope. Endoscopy was also used during the follow-up examinations. The results indicated that both treatments were effective and well tolerated by the patients. After eight weeks, the healing rate was 97.6 percent with sucralfate and 95.2 percent with ranitidine. Relapse rates were comparable as well; after one year, 31 percent of the sucralfate patients and 34 percent of the ranitidine patients had developed relapses. However, it was noted that the relapses among the patients treated with sucralfate were more likely to cause painful symptoms. In contrast, the ranitidine-treated patients generally developed relapses that, while visible on endoscopy, were not associated with any symptoms. Smoking seemed to have little effect on short-term ulcer healing. (Consumer Summary produced by Reliance Medical Information, Inc.)

Gastrointestinal mucosa

Similar abstracts:

• Abstracts: Treatment of AIDS with combinations of antiviral agents: a summary. Antiretroviral therapy in combination with interferon for AIDS-related Kaposi's sarcoma
• Abstracts: Pathophysiology of vascular disease in diabetes: effects of gliclazide. Oral treatment of diabetes mellitus: the contribution of gliclazide
• Abstracts: Enhancement of the protective qualities of gastric mucus by sucralfate: role of phosphoinositides. The effects of sucralfate and luminal stasis on recovery of the chambered rat gastric mucosa from taurocholate-induced damage
• Abstracts: Mechanisms of gastroduodenal protection by sucralfate. Acid secretory changes and early relapse following duodenal ulcer healing with ranitidine or sucralfate

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.