Clinical efficacy of sucralfate in reflux esophagitis. Comparison with cimetidine

Sucralfate has been evaluated in reflux esophagitis, based on its protective adherence to denuded surfaces, its bile salt-binding properties, and its cytoprotective properties. Histamine (H2)-receptor blockers are currently considered the standard therapy. The goal of this study was to compare the potential efficacy of sucralfate with that of cimetidine. A single-blind, randomized, multicenter study was performed in 42 patients with endoscopically documented reflux esophagitis. Patients were randomly given 1 g of sucralfate suspension four times daily or 400 mg of cimetidine four times daily for eight weeks. Forty patients were evaluated after eight weeks. Symptomatic improvement was good and comparable in both groups. In two patients given sucralfate and one given cimetidine, side effects were noted but did not necessitate withdrawal from the study. Endoscopy showed improvement in 53 percent of patients and healing of esophagitis in 31 percent after sucralfate treatment. With cimetidine, improvement was seen in 67 percent and healing occurred in 14 percent. In one patient receiving cimetidine, distal esophageal stenosis developed, requiring dilatation therapy. It is concluded that treatment with sucralfate improves the symptomatology and severity of reflux esophagitis. The results obtained with sucralfate appear comparable to those with cimetidine. Sucralfate may therefore be considered as a valid alternative to H2-receptor antagonist therapy in treating reflux esophagitis.