Sucralfate for the prevention of early rebleeding following injection sclerotherapy for esophageal varices.
One hundred eighty patients with variceal bleeding and treated by long-term sclerotherapy were randomized into a prospective randomized controlled clinical trial to assess the efficacy of sucralfate in reducing the frequency of rebleeding from esophageal ulceration prior to variceal obliteration. Overall, 29 (32%) of the 92 patients treated with the addition of sucralfate rebled, compared to 37 (42%) of 88 patients managed by sclerotherapy alone (p less than 0.10), but when patients with well-compensated liver disease were considered, the respective figures were 14 (24%) and 25 (42%)--a statistically significant difference (p less than 0.05). The frequency (approximately 70%), number (per patient) and extent of sclerotherapy-induced esophageal mucosal ulceration were not different for the two groups, although proven rebleeding from the ulceration occurred less frequently in those receiving sucralfate (10 and 20 occasions, respectively, p less than 0.05). Mortality was not different for the two groups. Thus, use of sucralfate will reduce the frequency of rebleeding during long-term treatment by sclerotherapy, although benefit appears to be restricted to well-compensated patients and without an endoscopic overt effect upon esophageal mucosal ulceration.
Polson
R J
RJ
Liver Unit, King's College Hospital, London, United Kingdom.
Westaby
D
D
Gimson
A E
AE
Hayes
P C
PC
Stellon
A J
AJ
Hayllar
K
K
Williams
R
R
D003131:Combined Modality Therapy; D004935:Esophageal Diseases / Q000209:etiology; D004932:Esophageal and Gastric Varices / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D005260:Female; D005756:Gastritis / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008107:Liver Diseases / Q000150:complications / Q000473:pathology; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012597:Sclerosing Solutions / Q000009:adverse effects / Q000627:therapeutic use*; D013392:Sucralfate / Q000009:adverse effects / Q000627:therapeutic use*; D013997:Time Factors; D014456:Ulcer / Q000209:etiology
D012597:Sclerosing Solutions; D013392:Sucralfate