The mechanism of protective, therapeutic and prophylactic actions of sucralfate

Sucralfate, a non-systemic drug, speeds the healing of peptic ulcers, prevents their recurrence and prevents stress ulcerations in critically ill patients. In animal experiments sucralfate protects the gastric mucosa against damage produced by ulcerogenic and necrotizing agents. Sucralfate does not inhibit gastric acid secretion and has a minimal neutralizing capacity. The basis for the acute protective action of sucralfate is its effect on the normal gastric mucosa enhancing the natural defensive mechanisms, stimulating mucus, bicarbonate and prostaglandin release and mucosal cell renewal. Therapeutic action of sucralfate is most likely the result of A) local action on ulcerated areas of the mucosa by formation of a protective barrier reducing pepsin and H+injury; B) binding of pepsin and bile acids; and C) trophic effect on the entire mucosa which facilitates healing and re-epithelialization. Long term prophylactic efficacy of sucralfate is probably due to its chronic trophic action on the gastric mucosa. Quantitive and qualitative increase in the surface epithelial and proliferative zone cells enhance the defensive capabilities of the mucosa increasing mucus, bicarbonate, and prostaglandin release and cell renewal.