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Sucralfate for NSAID-Induced Gastroduodenal Lesions

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Sucralfate

Abstract

Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely used in clinical practice. Their analgesic and anti-inflammatory properties make them useful in many common acute and chronic disorders, especially in various rheumatic and musculoskeletal disorders. However, NSAIDs are often associated with side effects of the gastrointestinal system, producing gastrointestinal symptoms and/or mucosal lesions such as erosions and/or ulcers. Possible complications of these lesions are perforation and hemorrhage, which can even lead to death, albeit rarely. If we consider the high frequency of rheumatic disease in the general population, particularly in the elderly and, consequently, the high consumption of these agents, which is bound to rise as the number of elderly people increases, the problem of NSAID-induced gastric lesions takes on particular importance in clinical terms, both for the physician and for the patient.

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References

  1. Roth SH: Nonsteroidal anti-inflammatory drug gastropathy. Arch Intern Med 146:1075–1076, 1986. Definition of gastrointestinal mucosal damage resulting from NSAID use.

    Article  PubMed  CAS  Google Scholar 

  2. Lanza FL: Endoscopic studies of gastric and duodenal injury after the use of ibuprofen, aspirin and other non-steroid anti-inflammatory agents. Am J Med 77(suppl 1A): 19–24, 1984. Demonstration of dose-dependent upper gastrointestinal mucosal injury induced by acetylsalicylic acid and other NSAIDs.

    PubMed  CAS  Google Scholar 

  3. Baskin WN, Ivey KJ, Krause WJ, et al: Aspirin induced ultrastructural changes in human gastric mucosa. Ann Intern Med 85:299–303, 1976. Description of ASA-induced microscopic alterations in gastric epithelial cells.

    PubMed  CAS  Google Scholar 

  4. O’Laughlin JC, Hoftiezer JW, Ivey KJ: Effects of aspirin on the human stomach in normals: Endoscopic comparison of damage produced one hour, 24 hours, and 2 weeks after administration. Scand J Gastroenterol 16(suppl 67):211–214, 1981. Acute aspirin administration appears to cause predominantly petechial hemorrhage in the fundus and antrum, while longer-term administration causes antrat and duodenal erosions.

    Google Scholar 

  5. Hoftiezer JW, O’Laughlin JC, Ivey KJ: Effects of 24 hours of aspirin, Bufferin, paracetamol and placebo on normal human gastroduodenal mucosa. Gut 23:692–697, 1982. Short-term use of both unbuffered and buffered aspirin causes upper gastrointestinal damage.

    Article  PubMed  CAS  Google Scholar 

  6. Hoftiezer JW, Silvoso GR, Burkis M, et al: Comparison of the effects of regular and enteric-coated aspirin on gastroduodenal mucosa in man. Lancet 2:609–612, 1980. Regular aspirin causes a greater amount of gastroduodenal mucosal damage than does enteric-coated aspirin.

    Article  PubMed  CAS  Google Scholar 

  7. Lanza FL, Royer GL, Nelson RS, et al: Effects of ibuprofen, indomethacin, aspirin, naproxen and placebo on the gastric mucosa of normal volunteers. Dig Dis Sci 24:823–828, 1979. Description of endoscopic changes induced by NSAIDs on upper gastrointestinal tract and their correlation with gastrointestinal complaints.

    Article  PubMed  CAS  Google Scholar 

  8. Lanza FL, Royer GL, Nelson RS: Endoscopic evaluation of the effects of aspirin, buffered aspirin, and enteric coated aspirin on gastric and duodenal mucosa. N Engt J Med 303:136–138, 1980. Buffered aspirin offers little protection to gastric and duodenal mucosa, while enteric-coated formulation is less damaging.

    Article  CAS  Google Scholar 

  9. Graham DY, Smith JL: Effects of aspirin and aspirin-acetaminophen combination on the gastric mucosa in normal subjects. Gastroenterology 88:1922–1925, 1985. Coadministration of acetaminophen with aspirin does not protect from mucosal injury induced by ASA.

    PubMed  CAS  Google Scholar 

  10. Graham DY, Smith JL, Holmes GI, et al: Nonsteroidal anti-inflammatory effect of sulindac sulfoxide and sulfide on gastric mucosa. Clin Pharmacol Ther 38:65–70, 1985. Evaluation of gastric mucosal damage induced by two different formulations of sulindac.

    Article  PubMed  CAS  Google Scholar 

  11. Graham DY, Smith JL, Dobbs SM: Gastric adaptations occurs with aspirin administration in man. Dig Dis Sci 28:1–6, 1983. Gastric mucosal adaptation may occur after continuous aspirin administration and is associated with reduced damage and an accelerated healing process.

    Article  PubMed  CAS  Google Scholar 

  12. Eliakim R, Ophir M, Rachmilewitz D: Duodenal mucosal injury with non-steroidal anti-inflammatory drugs. J Clin Gastroenterol 9:395–399, 1987. Description of the effects of various NSAIDs on duodenal mucosa.

    Article  PubMed  CAS  Google Scholar 

  13. Caruso I, Bianchi Porro G: Gastroscopic evaluation of anti-inflammatory agents. BrMed J 280:75–78, 1980. Importance of gastroscopy in assessing gastric tolerance of chronic NSAID therapy.

    CAS  Google Scholar 

  14. Silvoso GR, Ivey KJ, Butt JH, et al. Incidence of gastric lesions in patients with rheumatic disease on chronic aspirin therapy. Ann Intern Med 91:517–520, 1979. Endoscopic evaluation of the incidence and characteristics of gastric lesions using long-term ASA.

    PubMed  CAS  Google Scholar 

  15. Lockard OO, Ivey KJ, Butt JH, et al: The prevalence of duodenal lesions in patients with rheumatic disease on chronic aspirin therapy. Gastrointest Endosc 26:5–7, 1980. Patients on chronic ASA have a high prevalence of duodenal lesions, even though they lack upper gastrointestinal symptoms.

    Article  PubMed  Google Scholar 

  16. Miller R, Jick H: Acute toxicity of aspirin in hospitalized medical patients. Am J Med Sci 274:271–279, 1977. An analysis of the systemic side effects occurring on occasional or regular use of ASA.

    Article  PubMed  CAS  Google Scholar 

  17. Garner A: Effects of acetylsalicylate on alkalization, acid secretion and electrogenic properties in the isolated gastric mucosa. Acta Physiol Scand 99:281–291, 1977. Description of ASA action on secretive and electric activities of gastric mucosa.

    Article  PubMed  CAS  Google Scholar 

  18. Cohen MM, Clark L, Armstrong L, et al: Reduction of aspirin-induced fecal blood loss with low-dose misoprostol tablets in man. Dig Dis Sci 30:605–611, 1985. This study suggests that oral misoprostol reduces aspirin-induced gastrointestinal bleeding even when administered simultaneously and at a dose below its threshold for significant acid inhibition.

    Article  PubMed  CAS  Google Scholar 

  19. Rainsford KD: Anti-inflammatory drugs and the gastrointestinal mucosa. Gastroenterol Clin Biol 9(2bis):98–101, 1985. Description of mechanisms of NSAID-induced gastric mucosal damage.

    PubMed  CAS  Google Scholar 

  20. Hollander D, Tarnawski A, Gergely H, et al: Sucralfate protection of the gastric mucosa against ethanol-induced injury: A prostaglandin-mediated process? Scand J Gastroenterol 19(suppl 101):97–102, 1984. Prostaglandins mediate the protective action of sucralfate against ethanol-induced necrosis.

    CAS  Google Scholar 

  21. Crampton JR, Gibbons LC, Rees W: Effects of sucralfate on gastroduodenal bicarbonate secretion and prostaglandin E2 metabolism. Am J Med 83(suppl 3B):14–18, 1987. Sucralfate stimulates bicarbonate secretion by gastric and duodenal mucosa and prostaglandin E2 formation by mucosal homogenates.

    Article  PubMed  CAS  Google Scholar 

  22. Tarnawski A, Hollander D, Stachura J, et al: Effect of sucralfate in the normal human gastric mucosa. Endoscopic, histological and ultrastructural assessment. Scand J Gastroenterol 22(suppl 127):111–123, 1987. Macroscopic and microscopic examination of the gastric mucosa in direct contact with sucralfate.

    Article  Google Scholar 

  23. Nexo E, Poulsen SS: Does epidermal growth factor play a role in the action of sucralfate? Scand J Gastroenterol 22(suppl 127):45–49, 1987. Epidermal growth factor is attached to sucralfate at acid pH and accelerates gastric ulcer healing.

    Google Scholar 

  24. Stern AI, Ward F, Hartley G: Protective effect of sucralfate against aspirin-induced damage to the human gastric mucosa. Am J Med 83(suppl 3B):83–85, 1987. The protective action of sucralfate on the gastric mucosa of humans may be related to stimulation of endogenous prostaglandins.

    Article  PubMed  CAS  Google Scholar 

  25. Konturek SJ, Kwiecien N, Obtulowicz W, et al: Gastroprotection by sucralfate against acetylsalicylic acid in humans. Role of endogenous prostaglandins. Scand J Gastroenterol 22(suppl 140): 19–22, 1987. Sucralfate is significantly better than placebo in preventing gastroduodenal lesions induced by aspirin.

    Google Scholar 

  26. Tesler MA, Lim ES: Protection of gastric mucosa by sucralfate from aspirin-induced erosions. J Clin Gastroenterol 3(suppl 2): 175–179, 1981. The authors concluded that sucralfate provided complete or partial gastric mucosal protection from the gastrotoxic effects of 3.6 g aspirin when compared with placebo.

    PubMed  CAS  Google Scholar 

  27. Lanza FL, Graham DY, Davis RE, et al: Endoscopic comparison of cimetidine and sucralfate for prevention of naproxen-induced acute gastroduodenal injury. Effect of scoring method. Dig Dis Sci 35:1494–1499, 1990. This study indicates that H2-receptor antagonists are not effective in preventing gastric erosions and ulcers; more importantly, the authors raise doubts about the scoring system that has been widely used in studying this problem.

    Article  PubMed  CAS  Google Scholar 

  28. Malchow-Møller A, Ranløv PJ: Does sucralfate reduce acetylsalicylic-acid-induced gastric mucosal bleeding? Scand J Gastroenterol 22:550–552, 1987. Sucralfate did not prevent gastric microbleeding induced by administration of aspirin 1.0 g for 1 week.

    Article  PubMed  Google Scholar 

  29. Aabakken L, Larsen S, Osnes M: Sucralfate for prevention of naproxen-induced mucosal lesions in the proximal and distal gastrointestinal tract. Scand J Rheumatol 18:361–368, 1989. Sucralfate shows a mild protective effect on gastroduodenal lesions induced by naproxen.

    Article  PubMed  CAS  Google Scholar 

  30. Wu WC, Castell DO: Does sucralfate protect against aspirin-induced mucosal lesions? Yes and no! Gastroenterology 86:A1303, 1984. Sucralfate may be effective against the development of duodenal, but not gastric lesions induced by aspirin.

    Google Scholar 

  31. Stern AI, Ward F, Sievert W: Lack of gastric mucosal protection by sucralfate during long-term aspirin ingestion in humans. Am J Med 86(suppl 6A):66–69, 1989. Sucralfate 4 g daily lacks a mucosal protective capacity in human subjects ingesting large doses of aspirin over a 2-week period.

    Article  PubMed  CAS  Google Scholar 

  32. Caldwell JR, Roth SH, Wu WC, et al: Sucralfate treatment of nonsteroidal anti-inflammatory drug-induced gastrointestinal symptoms and mucosal damage. Am J Med 83(suppl 3B):74–82, 1987. Sucralfate positively influences dyspeptic symptoms but not gastric or duodenal lesions from NSAIDs.

    Article  PubMed  CAS  Google Scholar 

  33. Shepherd HA, Fine D, Hillier K, et al: Effect of sucralfate and cimetidine on rheumatoid patients with active gastroduodenal lesions who are taking nonsteroidal anti-inflammatory drugs. A pilot study. Am J Med 86(suppl 6A):49–54, 1989. Sucralfate and cimetidine administration resulted in improved gastroduodenal scores in patients with rheumatoid arthritis continuing with NSAID therapy.

    Article  PubMed  CAS  Google Scholar 

  34. Agrawal NM, Roth S, Graham DY, et al: Misoprostol compared with sucralfate in the prevention of nonsteroidal anti-inflammatory drug-induced gastric ulcer. A randomized, controlled trial. Ann Intern Med 115:195–200, 1991. Misoprostol is better than sucralfate in long-term (up to 12 weeks) prevention.

    PubMed  CAS  Google Scholar 

  35. Manniche C, Malchow-Møller A, Anderson JR, et al: Randomized study of the influence of nonsteroidal anti-inflammatory drugs on the treatment of peptic ulcer in patients with rheumatic disease. Gut 28:226–229, 1987. In this study, 77% of gastroduodenal ulcers were healed with ranitidine 150 mg twice daily or sucralfate 1 g four times daily despite continued NSAID use.

    Article  PubMed  CAS  Google Scholar 

  36. Bianchi Porro G, Santalucia F, Petrillo M: Omeprazole versus sucralfate in the treatment of NSAID-induced gastric and duodenal ulcer. Gut 31:A1175, 1990. Omeprazole is better than sucralfate in treatment of gastric and duodenal ulcers in patients taking NSAIDs.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Gastrointestinal Unit, L. Sacco Hospital, 20157, Milan, Italy

    G. Bianchi Porro & F. Santalucia

Authors
  1. G. Bianchi Porro
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  2. F. Santalucia
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Editor information

Editors and Affiliations

  1. Dean’s Office, University of Kansas School of Medicine, Kansas City, 66161-7300

    Daniel Hollander M.D.

  2. Department of Gastroenterology-Hepatology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands

    Guido N. J. Tytgat M.D.

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© 1995 Plenum Press

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Porro, G.B., Santalucia, F. (1995). Sucralfate for NSAID-Induced Gastroduodenal Lesions. In: Hollander, D., Tytgat, G.N.J. (eds) Sucralfate. Springer, Boston, MA. https://doi.org/10.1007/978-0-585-32154-7_27

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  • DOI: https://doi.org/10.1007/978-0-585-32154-7_27

  • Publisher Name: Springer, Boston, MA

  • Print ISBN: 978-0-306-44740-2

  • Online ISBN: 978-0-585-32154-7

  • eBook Packages: Springer Book Archive

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