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Oral Viscous Sucralfate Gel for Post-procedural Treatment of Barrett's Esophagus

Author(s):  Zur Eyal

Issue:  Sep/Oct 2019 - Volume 23, Number 5
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Note:  Electronic version includes supplemental material.

Abstract:  Barrett's esophagus refers to an abnormal change in the cells of the lower portion of the esophagus. It is characterized by the replacement of the normal stratified squamous epithelium lining of the esophagus by columnar epithelium cells which are usually found lower in the gastrointestinal tract. The medical significance of this pathology is approximately 0.5% risk to develop esophageal adenocarcinoma (per patient diagnosed with Barrett's esophagus per year). Diagnosis requires endoscopy and biopsy. In general, high-grade dysplasia and early stages of adenocarcinoma can be treated by endoscopic resection and/or endoscopic ablative therapy, whereas advanced stages (submucosal) are generally advised to undergo surgical treatment. Patients who undergo endoscopic resection and/or endoscopic ablative therapy might suffer from retrosternal discomfort and transient dysphagia, adverse effects that sometimes accompanies these procedures. One of the common post-procedural treatments is sucralfate 1 g 3 to 4 times daily for two weeks after the procedure. The rational for this treatment is to enhance the wound-healing process in the esophagus tissues and to coat the wounded tissues with a cytoprotective agent. As no clinical trials have been performed in order to prove the efficacy of sucralfate in the postprocedural treatment of Barrett's esophagus, this article summarizes the clinical experience accumulated from the treatment with sucralfate as a wound-healing enhancer. In addition, the article deals with the hypothesized mechanism of action of sucralfate and gives one option for compounding sucralfate oral viscous gel.

Related Keywords: Eyal Zur, BScPharm, RPh, MBA, Barrett esophagus, columnar epithelium, high-grade dysplasia, endoscopic therapy, adenocarcinoma risk factor, surgical wound healing, mucoadhesive sucralfate preparations, gastrointestinal reflux disease, GERD, viscous adhesive preparations, mucosal ulcers, mucosal erosion, formulations


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