Abstract
BACKGROUND: Sucralfate does not have potent anti-ulcerogenic actions in users of non-steroidal anti-inflammatory drugs (NSAIDs). However, sucralfate may influence intragastric haemostasis favourably. AIM: To investigate separately the effects of sucralfate on acute gastric and duodenal injury and on changes in intragastric bleeding induced by aspirin. METHOD: On three occasions, 24 healthy volunteers received three days' treatment with aspirin 900 mg twice daily together with placebo, sucralfate 2 g twice daily or sucralfate 1 g four times daily. Injury was assessed endoscopically and bleeding by spontaneous and biopsy induced bleeding intragastric washings. Ex vivo prostaglandin E2 (PGE2) synthesis and serum thromboxane were measured by using radioimmunoassay. RESULTS: Aspirin significantly inhibited ex vivo gastric mucosal PGE2 synthesis, reduced serum thromboxane, caused gastric erosions, and increased spontaneous and biopsy induced bleeding. Sucralfate had no significant effects on endoscopic injury but sucralfate 1 g four times daily significantly reduced spontaneous and biopsy induced bleeding. Similar trends were seen with sucralfate 2 g twice daily but the results were less consistent. CONCLUSION: Sucralfate does not affect aspirin induced acute gastric mucosal injury but reduces aspirin associated intragastric bleeding.
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Selected References
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- Agrawal N. M., Roth S., Graham D. Y., White R. H., Germain B., Brown J. A., Stromatt S. C. Misoprostol compared with sucralfate in the prevention of nonsteroidal anti-inflammatory drug-induced gastric ulcer. A randomized, controlled trial. Ann Intern Med. 1991 Aug 1;115(3):195–200. doi: 10.7326/0003-4819-115-3-195. [DOI] [PubMed] [Google Scholar]
- Ben-Menachem T., Fogel R., Patel R. V., Touchette M., Zarowitz B. J., Hadzijahic N., Divine G., Verter J., Bresalier R. S. Prophylaxis for stress-related gastric hemorrhage in the medical intensive care unit. A randomized, controlled, single-blind study. Ann Intern Med. 1994 Oct 15;121(8):568–575. doi: 10.7326/0003-4819-121-8-199410150-00003. [DOI] [PubMed] [Google Scholar]
- Cole A. T., Brundell S., Hudson N., Hawthorne A. B., Mahida Y. R., Hawkey C. J. Ranitidine, aspirin, food, and the stomach. BMJ. 1992 Feb 29;304(6826):544–545. doi: 10.1136/bmj.304.6826.544-a. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cole A. T., Brundell S., Hudson N., Hawthorne A. B., Mahida Y. R., Hawkey C. J. Ranitidine: differential effects on gastric bleeding and mucosal damage induced by aspirin. Aliment Pharmacol Ther. 1992 Dec;6(6):707–715. doi: 10.1111/j.1365-2036.1992.tb00735.x. [DOI] [PubMed] [Google Scholar]
- Cook D. J., Reeve B. K., Guyatt G. H., Heyland D. K., Griffith L. E., Buckingham L., Tryba M. Stress ulcer prophylaxis in critically ill patients. Resolving discordant meta-analyses. JAMA. 1996 Jan 24;275(4):308–314. [PubMed] [Google Scholar]
- Eddleston J. M., Pearson R. C., Holland J., Tooth J. A., Vohra A., Doran B. H. Prospective endoscopic study of stress erosions and ulcers in critically ill adult patients treated with either sucralfate or placebo. Crit Care Med. 1994 Dec;22(12):1949–1954. [PubMed] [Google Scholar]
- Ehsanullah R. S., Page M. C., Tildesley G., Wood J. R. Prevention of gastroduodenal damage induced by non-steroidal anti-inflammatory drugs: controlled trial of ranitidine. BMJ. 1988 Oct 22;297(6655):1017–1021. doi: 10.1136/bmj.297.6655.1017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hawkey C. J., Hawthorne A. B., Hudson N., Cole A. T., Mahida Y. R., Daneshmend T. K. Separation of the impairment of haemostasis by aspirin from mucosal injury in the human stomach. Clin Sci (Lond) 1991 Oct;81(4):565–573. doi: 10.1042/cs0810565. [DOI] [PubMed] [Google Scholar]
- Hawkey C. J., Somerville K. W., Marshall S. Prophylaxis of aspirin-induced gastric mucosal bleeding with ranitidine. Aliment Pharmacol Ther. 1988 Jun;2(3):245–252. doi: 10.1111/j.1365-2036.1988.tb00694.x. [DOI] [PubMed] [Google Scholar]
- Hawkey C. J. Synthesis of prostaglandin E2, thromboxane B2 and prostaglandin catabolism in gastritis and gastric ulcer. Gut. 1986 Dec;27(12):1484–1492. doi: 10.1136/gut.27.12.1484. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Hawthorne A. B., Mahida Y. R., Cole A. T., Hawkey C. J. Aspirin-induced gastric mucosal damage: prevention by enteric-coating and relation to prostaglandin synthesis. Br J Clin Pharmacol. 1991 Jul;32(1):77–83. doi: 10.1111/j.1365-2125.1991.tb05616.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Jensen D. M., Cheng S., Kovacs T. O., Randall G., Jensen M. E., Reedy T., Frankl H., Machicado G., Smith J., Silpa M. A controlled study of ranitidine for the prevention of recurrent hemorrhage from duodenal ulcer. N Engl J Med. 1994 Feb 10;330(6):382–386. doi: 10.1056/NEJM199402103300602. [DOI] [PubMed] [Google Scholar]
- Malchow-Møller A., Ranløv P. J. Does sucralfate reduce acetylsalicylic-acid-induced gastric mucosal bleeding? Scand J Gastroenterol. 1987 Jun;22(5):550–552. doi: 10.3109/00365528708991896. [DOI] [PubMed] [Google Scholar]
- Norrman B., Wallén P., Rånby M. Fibrinolysis mediated by tissue plasminogen activator. Disclosure of a kinetic transition. Eur J Biochem. 1985 May 15;149(1):193–200. doi: 10.1111/j.1432-1033.1985.tb08911.x. [DOI] [PubMed] [Google Scholar]
- Patchett S. E., O'Donoghue D. P. Pharmacological manipulation of gastric juice: thrombelastographic assessment and implications for treatment of gastrointestinal haemorrhage. Gut. 1995 Mar;36(3):358–362. doi: 10.1136/gut.36.3.358. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Penston J. G., Wormsley K. G. Nine years of maintenance treatment with ranitidine for patients with duodenal ulcer disease. Aliment Pharmacol Ther. 1992 Oct;6(5):629–645. doi: 10.1111/j.1365-2036.1992.tb00577.x. [DOI] [PubMed] [Google Scholar]
- Reusser P., Gyr K., Scheidegger D., Buchmann B., Buser M., Zimmerli W. Prospective endoscopic study of stress erosions and ulcers in critically ill neurosurgical patients: current incidence and effect of acid-reducing prophylaxis. Crit Care Med. 1990 Mar;18(3):270–274. doi: 10.1097/00003246-199003000-00004. [DOI] [PubMed] [Google Scholar]
- Robinson M. G., Griffin J. W., Jr, Bowers J., Kogan F. J., Kogut D. G., Lanza F. L., Warner C. W. Effect of ranitidine on gastroduodenal mucosal damage induced by nonsteroidal antiinflammatory drugs. Dig Dis Sci. 1989 Mar;34(3):424–428. doi: 10.1007/BF01536266. [DOI] [PubMed] [Google Scholar]
- Ruiz-Santana S., Ortiz E., Gonzalez B., Bolaños J., Ruiz-Santana A. J., Manzano J. L. Stress-induced gastroduodenal lesions and total parenteral nutrition in critically ill patients: frequency, complications, and the value of prophylactic treatment. A prospective, randomized study. Crit Care Med. 1991 Jul;19(7):887–891. doi: 10.1097/00003246-199107000-00011. [DOI] [PubMed] [Google Scholar]
- Silverstein F. E., Graham D. Y., Senior J. R., Davies H. W., Struthers B. J., Bittman R. M., Geis G. S. Misoprostol reduces serious gastrointestinal complications in patients with rheumatoid arthritis receiving nonsteroidal anti-inflammatory drugs. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1995 Aug 15;123(4):241–249. doi: 10.7326/0003-4819-123-4-199508150-00001. [DOI] [PubMed] [Google Scholar]
- Taha A. S., Hudson N., Hawkey C. J., Swannell A. J., Trye P. N., Cottrell J., Mann S. G., Simon T. J., Sturrock R. D., Russell R. I. Famotidine for the prevention of gastric and duodenal ulcers caused by nonsteroidal antiinflammatory drugs. N Engl J Med. 1996 May 30;334(22):1435–1439. doi: 10.1056/NEJM199605303342204. [DOI] [PubMed] [Google Scholar]
- Tryba M., Zevounou F., Torok M., Zenz M. Prevention of acute stress bleeding with sucralfate, antacids, or cimetidine. A controlled study with pirenzepine as a basic medication. Am J Med. 1985 Aug 30;79(2C):55–61. doi: 10.1016/0002-9343(85)90574-1. [DOI] [PubMed] [Google Scholar]
- Zäch G. A., Gyr K. E., von Alvensleben E., Mills J. G., Stalder G. A., Dunn S. L., Bloom S. A double-blind randomized, controlled study to investigate the efficacy of cimetidine given in addition to conventional therapy in the prevention of stress ulceration and haemorrhage in patients with acute spinal injury. Digestion. 1984;29(4):214–222. doi: 10.1159/000199036. [DOI] [PubMed] [Google Scholar]
