Advertisement

Sucralfate pp 257-270 | Cite as

Prevention of Ulcer Recurrence

  • Hans R. Koelz

Abstract

Peptic ulcer disease is a recurrent illness. Within the first year after healing of an acute ulceration, at least one further ulcer attack will occur in approximately 70% of patients with duodenal and in approximately 50% of those with gastric ulcers. Every recurrent ulceration bears the risk of medical and economic complications.

Keywords

Gastric Ulcer Peptic Ulcer Disease Eradication Therapy Ulcer Recurrence Ulcer Complication 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Bauerfeind P, Blum AL (editors), and 57 co-authors: Ulkusalmanach 1 + 2. Zweite, erweiterte Auflage. Berlin, Springer-Verlag, 1990. This is probably the most comprehensive recent compilation of data on peptic ulcer disease. It includes critical reviews on current topics and an analysis of 1735 original publications. Unfortunately, the 835-page volume is available in German only.Google Scholar
  2. 2.
    Alexander-Williams J: A requiem for vagotomy. Despite the last efforts of surgeons. Br Med J 302:547–548, 1991. In view of the efficacy of current antiulcer drugs and eradication therapy of H pylori, one of the major protagonists of vagotomy for peptic ulcer fails to see any further role for vagotomy in peptic ulcer disease.CrossRefGoogle Scholar
  3. 3.
    Lanas A, Sekar MC, Hirschowitz BI: Objective evidence of aspirin use in both ulcer and nonulcer upper and lower gastrointestinal bleeding. Gastroenterology 103:862–869, 1992. Measurement of platelet cyclooxygenase activity in gastrointestinal bleeding reveals that 80% of the patients were currently taking aspirin. 21.5% of the patients were not aware of, or did not admit, current aspirin consumption.PubMedGoogle Scholar
  4. 4.
    Koelz HR: Antisecretory versus protective drugs, in Halter F, Garner A, Tytgat GNJ (eds): Mechanisms of Peptic Ulcer Healing. Dordrecht, Kluwer Academic Publishers, 1991, pp 231–242. The two major groups of antiulcer drugs are reviewed, in particular also with respect to potential advantages of sucralfate in smokers.Google Scholar
  5. 5.
    Behar J, Roufail W, Thomas E, et al: Efficacy of sucralfate in the prevention of recurrence of duodenal ulcers. J Clin Gastroenterol 9(suppl 1):23–30, 1987. Placebo-controlled, double-blind randomized study in duodenal ulcer patients demonstrating clear superiority of sucralfate.PubMedCrossRefGoogle Scholar
  6. 6.
    Blum AL, Bethge H, Bode JC, et al: Sucralfate in the treatment and prevention of gastric ulcer: Multicentre double blind placebo controlled study. Gut 31:825–830, 1990. This study confirms the efficacy of sucralfate in gastric ulcers. Patients who have never taken NSAIDs had a higher recurrence rate than those who had but had stopped at entry of the study.PubMedCrossRefGoogle Scholar
  7. 7.
    Bolin TD, Davis AE, Duncombe VM, et al: The role of maintenance sucralfate in prevention of duodenal ulcer recurrence. Am J Med 83(suppl 3B):91–94, 1987. Double-blind, placebo-controlled, randomized study in prevention of duodenal ulcer with sucralfate 1 g twice daily.PubMedCrossRefGoogle Scholar
  8. 8.
    Bynum TE: Sucralfate l g twice a day prevents duodenal ulcer recurrence (abstract). Gastroenterology 94:A56, 1988. Preliminary results of a double-blind, randomized, placebo-controlled study with sucralfate in prevention of duodenal ulcer. The duration of treatment was limited to 3 months.Google Scholar
  9. 9.
    Classen M, Bethge H, Brunner G, et al: Effect of sucralfate on peptic ulcer recurrence: A controlled double-blind multicenter study. Scand J Gastroenterol 18(suppl 83):61–68, 1983. Prophylactic treatment of patients with duodenal or gastric ulcers with sucralfate 1 g twice daily or placebo for 6 months. Sucralfate prevented recurrence of duodenal ulcers, but a significant difference was not found in gastric ulcers.Google Scholar
  10. 10.
    Garcia-Paredes J, Diaz Rubio M, Llenas F, et al: Comparison of sucralfate and ranitidine in the treatment of duodenal ulcers. Am J Med 91(suppl 2A):64S–67S, 1991. Single-blind comparison of sucralfate 1 g twice daily and ranitidine 150 mg daily for up to 12 months in duodenal ulcer disease. The relapse rates were significantly lower in sucralfate-treated patients after 6 months.PubMedCrossRefGoogle Scholar
  11. 11.
    Herrerias-Gutierrez JM, Pardo L, Segu JL: Sucralfate versus ranitidine in the treatment of gastric ulcer. Randomized clinical results in short-term and maintenance therapy. Am J Med 86(suppl 6A):94–97, 1989. Randomized, but open, prophylactic treatment of patients with gastric ulcers showing no significant differences. The low number of patients precludes firm conclusions.PubMedCrossRefGoogle Scholar
  12. 12.
    Hui WM, Lam SK, Lok AS, et al: Maintenance therapy for duodenal ulcer: A randomized controlled comparison of seven forms of treatment. Am J Med 92:265–274, 1992. Large randomized trial on the preventive effect of several different regimens of prophylactic long-term drug treatment. The “single-blind” design is a serious drawback.PubMedCrossRefGoogle Scholar
  13. 13.
    Jean F, Bannefond A, Gislon J, et al: Traitement d’entretien de la maladie ulcéreuse. Etude multicentrique comparative du sucralfate, de la cimétidine et placébo. Rev Med Interne 6:321–326, 1985. Randomized trial with three small groups of patients. Therefore, and because cimetidine treatment was not blinded, clinically relevant differences between sucralfate and cimetidine cannot be excluded on the basis of this study.PubMedCrossRefGoogle Scholar
  14. 14.
    Marks IN, Girdwood AH, Newton KA, et al: A maintenance regimen of sucralfate 2 g at night for reduced relapse rate in duodenal ulcer disease. A one-year follow-up study. Am J Med 86(suppl 6A):136–140, 1989. Convenient dose of sucralfate (2 g at bedtime). Patients who had acute treatment with or including sucralfate had a lower recurrence rate at 6 months.PubMedCrossRefGoogle Scholar
  15. 15.
    Marks IN, Girdwood AH, Wright JP, et al: Nocturnal dosage regimen of sucralfate in maintenance treatment of gastric ulcer. Am J Med 83(suppl 3B):95–98, 1987. This is the only randomized study available showing a reduction of the relapse rate of gastric ulcers with prophylactic sucralfate treatment using a regimen of 2 g at bedtime.PubMedCrossRefGoogle Scholar
  16. 16.
    Marks IN, Girdwood AH: Recurrence of duodenal ulceration in patients on maintenance sucralfate. S Afr Med J 67:626–628, 1985. Comparison of sucralfate 1 g twice daily, 1 g at bedtime, and no treatment in prevention of duodenal ulcer. The marginal efficacy of the lower dose of sucralfate does not support its use.PubMedGoogle Scholar
  17. 17.
    Marks IN, Wright JP, Girdwood AH, et al: Maintenance therapy with sucralfate reduces rate of gastric ulcer recurrence. Am J Med 79(suppl 2C):32–35, 1985. Double-blind, randomized, placebo-controlled trial. Prophylactic treatment with sucralfate 1 g in the morning and 2 g at bedtime prevents approximately 50% of gastric ulcer relapses.PubMedCrossRefGoogle Scholar
  18. 18.
    Masoero G, Rocchia F, Rossanino A, et al: Comparison of ranitidine and sucralfate in the long-term treatment of duodenal ulcer. J Clin Gastroenterol 8:624–627, 1986. Randomized open trial comparing sucralfate 1 g twice daily and ranitidine 150 mg. Relapse rates at 12 months were identical, but tended to lower earlier with ranitidine treatment.PubMedCrossRefGoogle Scholar
  19. 19.
    Miyake T, Ariyoshi J, Suzaki T, et al: Endoscopic evaluation of the effect of sucralfate therapy and other clinical parameters on the recurrence rate of gastric ulcers. Dig Dis Sci 25:1–7, 1980. Single-blind, placebo-controlled, randomized trial of sucralfate 1 g four times daily and an antacid. No significant difference in relapses of gastric ulcer was found in a relatively large study population.PubMedCrossRefGoogle Scholar
  20. 20.
    Moshal MG, Spitaels MM, Manion GL: Double-blind placebo-controlled evaluation of one year therapy with sucralfate in healed duodenal ulcer. Scand J Gastroenterol 18(suppl 83):57–59, 1983. Double-blind trial comparing placebo and sucralfate in an unusual dose (three times 0.5 g and 1 g at bedtime).Google Scholar
  21. 21.
    Pääkkonen M, Aukee S, Janatuinen E, et al: Sucralfate as maintenance treatment for the prevention of duodenal ulcer recurrence. Am J Med 86(suppl 6A):133–135, 1989. Double-blind placebo-controlled trial in patients with healed duodenal and pyloric (about 25%) ulcers showing superiority of sucralfate.PubMedCrossRefGoogle Scholar
  22. 22.
    Rodrigo L, Berenger J, Hinojasa J, et al: Sucralfate and cimetidine as maintenance treatment in the prevention of duodenal ulcer recurrence. Am J Med 85(suppl 3B):99–104, 1987. Single-blind randomized study comparing sucralfate 1 g twice daily and cimetidine 400 mg for 6 months, with a follow-up for additional 6 months without therapy. No significant differences were observed.CrossRefGoogle Scholar
  23. 23.
    Takemoto T, Kimura K, Okita K: Efficacy of sucralfate in the prevention of recurrence of peptic ulcer—Double-blind multicenter study with cimetidine. Scand J Gastroenterol 22(suppl 140): 49–60, 1987. Double-blind randomized trial in prevention of recurrent duodenal and gastric ulcers with three regimens: Sucralfate 1 g twice daily versus cimetidine 400 mg versus combination therapy. No significant differences were found.Google Scholar
  24. 24.
    Takemoto T, Namiki M, Ishikawa M, et al: Ranitidine and sucralfate as maintenance therapy for gastric ulcer disease: Endoscopic control and assessment of scarring. Gut 30:1692–1697, 1989. Large double-blind randomized study demonstrating superiority of ranitidine (150 mg) against sucralfate (1 g thrice daily) in gastric ulcer prevention.PubMedCrossRefGoogle Scholar
  25. 25.
    Tovey FI, Husband EM, Yiu YC, et al: Comparison of relapse rates and of mucosal abnormalities after healing of duodenal ulceration and after one year’s maintenance with cimetidine or sucralfate: A light and electron microscopy study. Gut 30:586–593, 1989. Single-blind randomized trial in a small population without significant differences in relapse rates.PubMedCrossRefGoogle Scholar

Copyright information

© Plenum Press 1995

Authors and Affiliations

  • Hans R. Koelz
    • 1
  1. 1.Department of MedicineTriemli HospitalZurichSwitzerland

Personalised recommendations