What is the role of sucralfate in the treatment of peptic ulcer disease?

From the Guidelines

Sucralfate should not be used as the primary treatment for peptic ulcer disease due to its limited efficacy compared to other medications, but it may be considered as an adjunctive therapy in certain cases. When considering the treatment of peptic ulcer disease, the primary goal is to reduce morbidity, mortality, and improve quality of life. According to a study published in Intensive Care Medicine 1, sucralfate was associated with a lower incidence of ventilator-associated pneumonia (VAP) compared to H2-receptor inhibitors, with a relative risk reduction (RRR) of 15.1. However, this study was focused on patients with severe sepsis and septic shock, and its findings may not be directly applicable to the general treatment of peptic ulcer disease.

Key Points to Consider

• Sucralfate may be associated with a lower risk of VAP compared to H2-receptor inhibitors, but its efficacy in treating peptic ulcer disease is limited compared to other medications 1.
• The use of sucralfate as an adjunctive therapy alongside proton pump inhibitors or H2 blockers may be considered in certain cases, particularly for patients at high risk of VAP.
• The standard dosage of sucralfate is 1 gram taken orally four times daily, but its effectiveness in treating peptic ulcer disease is generally lower than that of other medications.

Clinical Implications

The use of sucralfate in the treatment of peptic ulcer disease should be carefully considered, taking into account the potential benefits and limitations of this medication. While sucralfate may be associated with a lower risk of VAP, its efficacy in treating peptic ulcer disease is generally lower than that of other medications. As such, it is recommended to use sucralfate as an adjunctive therapy alongside other medications, rather than as a primary treatment for peptic ulcer disease.

From the FDA Drug Label

Although the mechanism of sucralfate’s ability to accelerate healing of duodenal ulcers remains to be fully defined, it is known that it exerts its effect through a local, rather than systemic, action These observations suggest that sucralfate’s antiulcer activity is the result of formation of an ulcer-adherent complex that covers the ulcer site and protects it against further attack by acid, pepsin, and bile salts.

The role of sucralfate in the treatment of peptic ulcer disease is to protect the ulcer site and accelerate healing through a local action, by forming an ulcer-adherent complex that covers the ulcer site and protects it against further attack by acid, pepsin, and bile salts 2.

• Key benefits of sucralfate include:
  • Inhibition of pepsin activity in gastric juice
  • Adsorption of bile salts
  • Barrier to diffusion of hydrogen ions
• Clinical trials have demonstrated the effectiveness of sucralfate in healing duodenal ulcers and preventing recurrence 2.

From the Research

Role of Sucralfate in Peptic Ulcer Disease

The use of sucralfate in the treatment of peptic ulcer disease is well-established, with several studies demonstrating its efficacy in healing duodenal and gastric ulcers.

• Sucralfate is a basic aluminium salt of sulphated sucrose that acts primarily at the ulcer site by protecting the ulcer from the effects of pepsin, acid, and possibly bile salts 3.
• It is minimally absorbed after oral administration and is believed to form a protective barrier at the ulcer site, inhibiting the diffusion of hydrogen ion, inhibiting the action of pepsin, and adsorbing bile salts 4.

Efficacy of Sucralfate

The efficacy of sucralfate in the treatment of peptic ulcer disease has been demonstrated in several studies, with healing rates comparable to those of cimetidine and intensive antacid therapy.

• Controlled therapeutic trials have shown 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 3.
• Healing rates for duodenal ulcer range from 60 to 90% at 4-6 weeks and up to 90% at 12 weeks for gastric ulcer 5.
• Sucralfate has also been shown to be effective in preventing the recurrence of duodenal ulcers, with a lower recurrence rate compared to cimetidine 6.

Safety and Tolerability

Sucralfate is generally well-tolerated, with few side effects reported.

• The most common side effect is constipation, which occurs in 2-4% of patients 3, 4.
• Other side effects include xerostomia and skin eruptions, but these are rare and generally mild 4.
• Sucralfate is considered to be one of the safest drugs available for the treatment of dyspeptic symptoms 6.