The effect of oral sucralfate on postprandial proximal gastric acid pocket

Luciana C. Silva, Fernando A. M. Herbella


Background: A postprandial proximal gastric acidpocket (PPGAP) that escapes neutralization by food was demonstrated involunteers and gastroesophageal reflux disease (GERD) patients. It is elusive;however, if this acid layer is morphologically best conceptualized as a realpocket or a film. This study aims to analyze the effect of oral sucralfateadministration on PPGAP to shed some light on PPGAP morphology and treatment.
Methods: Twenty-six patients (mean age 51years, 19 females) were studied. A pull-through pH monitoring was performedfrom 5 cm below the lower border of the lower esophageal sphincter (LES) to theactual border in increments of 1 cm, in a fasting state, 10 min after a fattymeal and 10 min after oral sucralfate administration. PPGAP was defined by anacid reading (pH <4) in the proximal stomach between non-acid segmentsdistally (food) and proximally (proximal pH transition point). Standard 24 h pHmonitoring was performed for objective characterization of GERD. The protocolwas approved by local ethics committee.
Results: PPGAP was not found in 15 patientsand these were excluded from the post-sucralfate analysis. After sucralfate,PPGAP increased in length in 5/11 (45%) patients; decreased in 2/11 patients(18%). In 3/11 (27%) patients PPGAP disappeared; in 1/11 (9%) PPGAP lengthremained equal.
Conclusions: In conclusion,sucralfate altered PPGAP in more than 90% of the patients, supporting thetheory of an acid film. Sucralfate is, however, not an adequate treatment forPPGAP.