| Peptic ulcer is a common frequently-occurring disease, which principal nosogenesis contains HP infection and the use of NSAIDs. The imbalance of the attack factors which lead to ulcer and the defense factors of the gastric mucosa is considered to be related to the pathogenesis of peptic ulcer. The attack factors contain gastric acid, pepsin and regurgitated bile etc. The defense factors contain mucosal barrier and mucosal repair function etc. Sucralfate is a kind of mucous protective agent, which could enhance the activity of the basic fibroblast growth factor (BFGF), and stimulate the mucosal function of defense and repair. Proton pump inhibitor (PPI), H2-receptor antagonist (H2-RA) and antacid can inhibit gastric acid secretion or neutralize gastric acid, eliminating or alleviating the mucousal damage of attack factor. Thus, it is usually to use combination therapy of sucralfate and antacid to increase therapeutic effect in clinic.Objective:1 Detecting the pH value when sucralfate formed to gel and determining the concentration of the aluminius ion dissociate from sucralfate.2 Using Meta-analysis to compare the effect of combination therapy of sucralfate and antacid with sucralfate monotherapy in patients with peptic ulcer.Methods:1 Study on the effect of pH on gel formation of sucralfate suspension and free aluminium ionDetecting the pH value when sucralfate formed to gel in vitroAdding varies volume of 0.1 mol·-1 HCL solution into 10 ml suspension of sucralfate, determing instant pH value and observing the change of the character of the mixture.Observing the change of the character when the suspension of sucralfate added into artificial gastric juice or artificial intestinal juice with different pH value.Preparing artificial gastric juice (pH value is 0.7) and artificial intestinal juice according to Chinese Pharmacopoeia (CP), then took 20 ml respectively mixed with 5 ml suspension of sucralfate to observing the change of the mixture. The pH value was adjusted to 0.1,1.0,2.0,3.0,4.0,5.0,6.0 and 7.0, then took 20 ml respectively and mixed with 5 ml suspension of sucralfate to observing the change of the mixture. The change of the character was recorded and the supernates were collected after 20h.Determining the concentration of the aluminium ion.Taking the series of the supernate which was laid aside 20 h, determining the concentration of the aluminium ion by inductively coupled plasma optical emission spectrometry (ICP-OES).2 Combination therapy of sucralfate and antacid compared with sucralfate monotherapy in peptic ulcer:a Meta-analysisWe search the databases including Cochrane library, MEDLINE, EMbase, Chinese biomedical literature database and CNKI to identify clinical randomized control trials in which the effects of combination therapy of sucralfate and antacid compared with sucralfate monotherapy in patients with peptic ulcer are studied and search the references of the literatures. We include related studies according to the inclusion criteria and exclusion criteria and assess the quality of literatures by Jadad scale. The data of patients’ basic information, drug use and outcome indicators including evaluation of clinical symptom effective rate, gastroscope recovery rate and ARDs occurrence rate are extracted. The RevMan 4.2 software is used for data analysis.Results:1. Study on the effect of pH on gel formation of sucralfate suspension and free aluminium ionDetecting the pH value when sucralfate formed to gel in vitroSucralfate could entirely dissolve when pH is 0.1, formate white, soft, strongly sticky and well extensibility gel when pH is 0.7,1.0 and 2.0, and as time goes by, it gradually formed to precipitation. It could not form to gel when pH is more than 3.0, and it could form to a kind of hard precipitation with no stickness and extensibility. When the pH value is in the range of 0.1 to 7.0, the concentration of the aluminium ion gradually decline with the pH rising.2 Combination therapy of sucralfate and antacid compared with sucralfate monotherapy in peptic ulcer:a Meta analysisThis Meta analysis preliminary search out 11 literatures, and eventually include 7 RCTs, involved 595 patients by screening. To compared the effects of combination therapy of sucralfate and antacid with sucralfate monotherapy in patients with peptic ulcer, the Meta analysis results show that there is no significant difference in clinical symptom effective rate [OR=1.6,95%CI (0.87,2.93), P=0.13], gastroscope recovery rate [OR=1.36,95%CI (0.87,2.12), P=0.17] and ARDs occurrence rate [OR=1.36, 95% CI (0.64,2.90), P=0.42].Conclusions:1 Sucralfate could form to gel when pH is 0.7,1.0 and 2.0, and could not form to gel when pH is more than 3.0. Combination therapy of sucralfate and antacid could not increase the absorption of the aluminium ion.2 The Meta analysis results show that there is no significant difference in clinical symptom effective rate, gastroscope recovery rate and ARDs occurrence rate. Combination therapy of sucralfate and antacid is not better than sucralfate monotherapy. |
