SUCRALFATE IN MANAGEMENT OF STRESS ULCERS: EXPLORING ITS ROLE IN ANGIOGENESIS, PROTECTIVE BARRIER FORMATION, AND NON-SYSTEMIC ACTION

Stress ulcers, or stress-related mucosal damage (SRMD), are a common complication in critically ill patients, characterised by erosions, ulcerations, and inflammation of the mucosa of the upper gastrointestinal (GI) tract. Patients in intensive care units (ICUs), particularly those on mechanical ventilation or with severe burns, trauma, sepsis, or coagulopathy, are at increased risk. Within the first 24 hours after hospitalisation, 75–100% of intensive care unit patients experience stress-related ulcers due to an imbalance between protective and aggressive gastric factors. If left untreated, stress ulcers can lead to significant complications, including gastrointestinal bleeding, increased morbidity, and prolonged hospital stays. Sucralfate binds to negatively charged alternatives due to its unique mechanism of action. It forms a protective barrier over ulcerated mucosa, promotes angiogenesis, and enhances mucosal healing without causing significant changes in gastric pH.. This characteristic reduces the likelihood of bacterial overgrowth and infection, making sucralfate a safer option for stress ulcer prophylaxis. Clinical studies have demonstrated that sucralfate effectively prevents stress-related gastrointestinal bleeding while maintaining a favourable safety profile. Sucralfate is added for the treatment regimen along with other acid suppressant drugs like PPIs and H2RAs in the treatment of stress ulcers. Sucralfate, when combined with PPIs and H2RAs, enhances healing and prevents complications by providing protection against acid, pepsin, and bile salts. This combination reduces the risk of bleeding and perforation, leading to faster recovery and shorter hospital stays. However, caution is necessary in patients with renal impairment due to the risk of aluminium accumulation. Given its protective properties, low risk of complications and adverse drug reactions, sucralfate represents a viable and safer add-on therapy for managing stress ulcers in critically ill patients.