Comparison of sucralfate and ranitidine in gastroprotection against alcohol in humans

This endoscopic study was designed to assess histologic and functional features of human gastric mucosal injury by 40 percent ethanol, and to compare the gastroprotective effects of sucralfate with those of ranitidine or sucralfate combined with ranitidine against ethanol damage. A group of 16 young subjects with normal gastric mucosa were divided into two groups (A and B). Group A was pretreated for four days with either sucralfate alone (1 g four times per day) or placebo (one tablet four times per day). Group B received sucralfate (1 g four times per day) plus ranitidine (150 mg three times per day) or placebo plus ranitidine in a double-blind, randomized study. On the fifth morning, two hours after the last treatment, 100 ml of 40 percent ethanol spray was applied via an endoscope onto gastric mucosa. In placebo-treated subjects, ethanol caused widespread endoscopic damage (score = 2.43) with histologic disruption of surface epithelium and deep necrotic lesions accompanied by a decrease of mucosal potential difference from -41.3 to -15.8 millivolts. Pretreatment with sucralfate significantly reduced endoscopic damage (score = 0.75). The surface epithelium was disrupted, but necrotic lesions were greatly reduced and potential difference decreased to -27.1 millivolts. Ranitidine alone or combined with sucralfate did not prevent ethanol-induced histologic or functional changes in the mucosa. Ethanol produces pronounced mucosal damage that can be almost completely prevented by sucralfate.