Bile salt binding by maalox, sucralfate, and meciadanol: in vitro and clinical comparisons.
Inhibition of gastric acid secretion is a major factor in protecting the gastric mucosa, although other mechanisms such as bile salt binding may contribute to the protective properties of individual agents. Sucralfate, antacid (Maalox), and Meciadanol, a new flavonoid, were compared with cholestyramine resin for binding bile salts. The free, glycine, and taurine conjugates of the human bile salts, cholate, chenodeoxycholate, and deoxycholate, were incubated with each of the above. Cholestyramine resin adsorbed 91-97% of all bile salts tested. Meciadanol adsorbed all of the bile salts fairly well except for the free forms of chenodeoxycholate and deoxycholate. Meciadanol (53 to 84%) adsorbed bile salts better than sucralfate (4.2 to 61%), and significantly (P less than 0.05) better than Maalox (10 to 47%). In our in vitro studies, sucralfate was not as effective in binding bile salts as previously reported. Patients in the surgical intensive care unit were randomized prospectively to receive nasogastric instillation of Maalox, sucralfate, or Meciadanol to prevent gastrointestinal bleeding. The gastric aspirates were analyzed for bile salt concentration. The mean bile salt concentration of those treated with Maalox (0.24 mM), Meciadanol (0.24 mM), or sucralfate (0.35 mM) was significantly lower than those treated with nasogastric aspiration (0.87 mM) alone (P less than 0.01). This suggests that these substances bind bile salts and may provide additional protection to the gastric mucosa along with their ability to neutralize gastric acid.
Lipsett
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Department of Surgery, Johns Hopkins Hospital, Baltimore, Maryland 21218.
Gadacz
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D000327:Adsorption; D000536:Aluminum Hydroxide / Q000008:administration & dosage / Q000378:metabolism* / Q000627:therapeutic use; D000863:Antacids / Q000378:metabolism*; D000897:Anti-Ulcer Agents / Q000378:metabolism*; D001647:Bile Acids and Salts / Q000378:metabolism*; D002392:Catechin / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000378:metabolism / Q000627:therapeutic use; D002635:Chenodeoxycholic Acid / Q000378:metabolism; D002792:Cholestyramine Resin / Q000378:metabolism; D019826:Cholic Acid; D002793:Cholic Acids / Q000378:metabolism; D002986:Clinical Trials as Topic; D003840:Deoxycholic Acid / Q000378:metabolism; D004338:Drug Combinations / Q000008:administration & dosage / Q000378:metabolism / Q000627:therapeutic use; D005750:Gastric Juice / Q000378:metabolism; D006471:Gastrointestinal Hemorrhage / Q000517:prevention & control; D006801:Humans; D008274:Magnesium / Q000378:metabolism*; D008276:Magnesium Hydroxide / Q000008:administration & dosage / Q000378:metabolism* / Q000627:therapeutic use; D013392:Sucralfate / Q000008:administration & dosage / Q000378:metabolism* / Q000627:therapeutic use
D000863:Antacids; D000897:Anti-Ulcer Agents; D001647:Bile Acids and Salts; D002793:Cholic Acids; D004338:Drug Combinations; D003840:Deoxycholic Acid; D002635:Chenodeoxycholic Acid; D002792:Cholestyramine Resin; C029339:meciadanol; C013591:aluminum hydroxide, magnesium hydroxide, drug combination; D013392:Sucralfate; D000536:Aluminum Hydroxide; D002392:Catechin; D019826:Cholic Acid; D008274:Magnesium; D008276:Magnesium Hydroxide