Why does sucralfate improve healing in reflux esophagitis? The role of sucrose octasulfate

In the present investigation, one of sucralfate's major components, sucrose octasulfate (SOS), is shown in vitro to protect human esophageal epithelium against acid injury. This was done by mounting sections of human epithelia obtained at the time of esophagectomy in Ussing chambers and monitoring the change in electric resistance (R) on luminal acidification with 60 mM HCl. Mucosal-to-serosal mannitol fluxes were also performed before and after exposure to HCl. In untreated control tissues luminal acidification progressively reduced R with time and significantly increased tissue permeability to mannitol. In contrast, tissues exposed to 10 mg/ml SOS showed a minimal decrease in R and no significant change in permeability to mannitol (p less than 0.05 compared with control for both factors). Since SOS does not buffer luminal H+, protection by SOS is mediated by a direct action on the tissue. The impact of these results on sucralfate's reported ability to improve healing in reflux esophagitis is discussed.