Efficacy of sucralfate in refractory reflux esophagitis. Results of a pilot study

Patients with severe reflux esophagitis unresponsive to standard medical therapy constitute a vexing clinical problem. We evaluated 8 patients with long-standing gastroesophageal reflux disease complicated by peptic stricture (n = 6), Barrett's esophagus (n = 5), bleeding esophageal ulcer (n = 2), and/or failure or prior antireflux surgery (n = 4), and 4 patients with rapidly advancing esophagitis following surgical resection of the cardia. After an 8-week course of full-dose H2-receptor antagonists, domperidone and antacids, marginal clinical improvement and unchanged or worsened endoscopic appearance of esophagitis was observed in all patients. Thereafter, in an attempt to enhance esophageal mucosal resistance, sucralfate alone (4.0 g/d) was given for 8 weeks. Both symptoms and endoscopic appearance improved in all patients after sucralfate, and the need for dilatation of strictures was lessened. On follow-up, complete healing of esophagitis was demonstrated by endoscopy in 6 patients after 4 to 6 months of uninterrupted sucralfate therapy. The results of this pilot study indicate that (cyto)protection with sucralfate has an important therapeutic potential in reflux esophagitis. They also suggest that impaired esophageal epithelial resistance is an important pathophysiological factor in persistence of esophageal inflammation in esophagitis refractory to conventional treatment.