Hi everyone,

Here is a statement I have pasted from marci-kids.com -

2. Sucralfate (Carafate)
This is an aluminum-containing, sticky sugar that binds to open, irritated
areas in the esophagus or stomach. The catch is that sucralfate requires
acid to become active. It also requires an irritated area. Because of these
two factors and since it has to be given quite frequently (4-6 times/day),
it is not highly useful for the treatment of acid related disorders. Note
sucralfate should not be used with antacids or with H-2 blockers or with PPI
drugs. This is because as was stated earlier, sucralfate requires an acid
environment to work.
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I understand that sucralfate forms a paste formed from gastric acid, that
binds to ulcer sites and creates a protective film, and that it works best
in an acid environment, preferably a pH below 4.0 (but I have also read in
one source that it may not require acid to work).  The statement above says
sucralfate should not be used with antacids or H2 blockers or PPI drugs.
The package insert for sucralfate references separating antacids (by 30
minutes), and H2's and other drugs by two hours (does not mention PPI's
which are about 10 times more effective at blocking acid than the H2
blockers).

If this is true (eg sucralfate should not be used with PPI drugs) then would
you please explain why some gastroenterologists and surgeons immediately
prescribe BOTH nexium 40 mg bi-daily, AND sucralfate four times a day (for
adults), when they find duodenal ulcers on endoscopic examination (kind of
like a double whammy, even though I understand the PPI's are the drugs of
choice and sucralfate is fading out).  But if the high dose of nexium raises
the pH significantly above 4 (which it will if it is working properly on the
person taking it), than why would the gastro's or surgeon prescribe the
sucralfate in addition to the nexium, if it would just be blunted by the
nexium creating the higher pH and not allowing the acid paste to form.  Does
the sucralfate still have some capability of forming the paste and have the
binding effect, even at a higher pH above 4 or 5.  If not then what a waste
of time and effort, especially since sucralfate is so hard to take with it's
one hour before and two to three hours after restrictions on eating and
don't take other pills within two hours of it to be safe, etc.  It becomes
almost impossible to eat or take other pills if you take the sucralfate four
times a day.

Please don't ask me to ask my doctor (I have been to too many doctors in my
life, and they don't like you doing research and questioning them,
especially with something that you study that disagrees with what they have
recommended).  You may get dismissed, if you know what I mean.

I would also like to know how sucralfate can bind to the esophagus if you
swallow the "pill form" with a glass of water and it immediately goes to
your gut (I believe the pills are way better than two teaspoons of the
suspension since the pill immediately dissolves in the water and IMO will be
able to disperse better and form the paste in the stomach and duodenum).
The package inserts indicate the healing rates for duodenal ulcers are much
higher for the pills than the suspension (at four weeks) and it also says
that equivalency of the suspension to the pill has not been demonstrated.  I
understand that swallowing two teaspoons of the suspension may cling to the
esophagus briefly but I would think the effect would be negligible if you
had esophageal erosions.  The drug is old and the data is old and calling
Axcan (the current pharma that owns it) is next to useless.

I would appreciate a response to my concerns.  Thank you...Pete