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The Effect of Oral Sucralfate on the Postprandial Proximal Gastric Acid Pocket
Luciana C. Silva*1, Fernando a. Herbella1, Marco G. Patti2
1Surgery, Federal University of Sao Paulo, Sao Paulo, Brazil; 2Department of Surgery, University of Chicago, Chicago, IL
BACKGROUND: An unbuffered layer of acidity that escapes neutralization by food has been demonstrated in volunteers and gastroesophageal reflux disease patients, corresponding to the postprandial proximal gastric acid pocket (PPGAP). It is elusive if this layer of acidity is best conceptualized as a "film" or as a "pocket". Previous studies showed that an alginate-antacid formulation, that forms a raft above the gastric contents, eliminates or displaces the PPGAP. However, there are no studies on the effect of mucosal coating drugs. This study aims to analyze the effect of oral sucralfate on PPGAP in GERD patients.
METHODS: Preliminary results in 10 patients (age 45 (43,5 - 60), 7 females) were studied. All patients underwent upper endoscopy to analyze the presence of hiatal hernia, esophagitis or Barrett's esophagus. Patients underwent a high-resolution manometry for localization of the lower border of the lower esophageal sphincter (LBLES). A station pull-through pH monitoring was performed from 5cm below the LBLES to the LBLES in increments of 1cm in a fasting state and 10min after a standardized fatty meal and also 10 min after oral administration of 2g sucralfate. Postprandial proximal gastric acid pocket was defined by the presence of acid reading (pH<4) in a segment of the proximal stomach between non-acid segments distally (food) and proximally (LBLES). The PPGAP extent and position were compared before and after sucralfate. Standard 24h pH monitoring was performed for objective characterization of GERD. The protocol was approved by local ethics committee.
Results: After sucralfate, PPGAP disappeared in 1 (12%) patient. PPGAP extent increased in 5 (62%) and diminished in 2 (25%)patients. Two patients (25%) had intraesphincteric PPGAP before sucralfate: in 1 of them (12%) the PPGAP moved down LBLES and in the other it disappeared. In 6 (75%) individuals PPGAG remained below the LBLES in both measurements. After meal, PPGAP was not found in two patients and these were excluded from the analysis.
CONCLUSIONS: Our results showed that: (1) sucralfate did not show a neutralization effect on the PPGAP, supporting the theory of acid pocket, not acid film, and (2) sucralfate is not an adequate treatment for the PPGAP.
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