CPD ARTICLE
Sucralfate also stimulates the synthesis of capillary blood flow-promoting prostaglandins potentiating the natural defence mechanisms of the gastrointestinal tract . Because sucralfate can also bind other oral drugs , medications should be given 1 – 2 hours prior to sucralfate administration , as absorption is minimal ,. Toxicity is uncommon . Long-term use may lead to constipation because of its aluminium content .
There is no evidence to support that simultaneous therapy with other antacids provides added benefit compared to therapy with either sucralfate or an antacid alone . However , conceptually the two differences mechanism of action would suggest that this practice may be beneficial . In cases suffering from oesophagitis it is important to note that only liquid solution is considered to be effective .
Misoprostol Misoprostol is valuable in managing cases suffering from nonsteroidal anti-inflammatory induced gastric ulceration . This drug is a synthetic prostaglandin E-analogue that can be used prophylactically or as treatment in these cases . It has been shown to significantly reduce aspirin-induced gastrointestinal ulceration compared to a placebo 12 . This study led to the suggested dose of 3 µ g / kg , q8h , PO . Where misoprostol was used to prevent ulceration in dogs with intervertebral disc disease which were given a single dose of dexamethasone at 2mg / kg followed by a tapering course of prednisolone ( 2 mg / kg to 0.5 mg / kg over the course of 5 – 6 days ), no effect was seen at a dose of 2 μg / kg , q8h PO 13 . The most common side effect is diarrhoea and the drug may also cause abortion .
Clinical Application of Antacids Despite the recent advances in our understanding of antacids in dogs and cats there is very little information on the effect of these drugs in animals with spontaneous disease . Most of the studies to date have been performed in healthy animals utilising criteria put forward in human medicine for the level and duration of acid suppression considered adequate to promote ulcer healing . There is even less information on the possible side effect of long-term use of particularly proton pump inhibitors and H2 antagonists . The lack of information makes it difficult to provide clear clinical guidelines and indications for the use of antacids .
A human a study revealing a highly significant correlation between acid suppression and ulcer healing has solidified the practice of using antacids in gastrointestinal ulceration and has been extrapolated to veterinary medicine 13 . Nowadays proton-pump inhibitors are commonly used in humans to treat all acid-related disorders such as peptic ulcers , Helicobacter-associated atrophic gastritis , mast cell neoplasia associated hyperhistaminaemia , gastroesophageal reflux disease and nonsteroidal anti-inflammatory drugs-associated gastroduodenal ulcers . In addition , antacids are also commonly used in conditions such as gastritis , pancreatitis , hepatic disease and renal disease .
Proton pump inhibitors are commonly employed in the treatment Helicobacter-associated atrophic gastritis despite little evidence to support this practice in dogs . The pathogenesis of gastrointestinal ulceration in hepatic disease is poorly understood and not well described in literature . Further studies are necessary to determine the efficacy of antacids for this application .
Gastrointestinal ulceration associated with hypovolaemia , ischaemia and focal peritonitis as seen in acute pancreatitis cases has led to the prophylactic use of antacids in these patients . However , no benefit was reported with the administration of proton pump inhibitors in a placebo-controlled study in humans with acute pancreatitis 14 and there have been no studies performaed in veterinary medicine to support this practice . Patients suffering from oesophagitis may also benefit from antacid therapy .
Chronic kidney disease is another common condition where antacids may be considered . End-stage renal disease in humans has been associated with hypergastrinaemia , gastritis , gastrointestinal bleeding and gastrointestinal ulceration but there are no reports evaluating the gastric acid secretion profile in dogs or cats with renal disease . Recent evidence suggests that gastric ulceration is not a feature of chronic kidney disease in cats as is seen in dogs and humans with uraemic gastritis 15 . This finding suggests that there is little evidence to justify the use of antacids prophylactically in cats with uraemia . A recent study evaluating the use of sucralfate as a phosphate binder in cats with chronic kidney disease was unable to confirm any benefit for its use in cats and the study had to be discontinued prematurely due to excessive vomiting , anorexia and increases in azotaemia in the group with chronic kidney disease 16 . Generally , there are less studies critically evaluating the efficacy of antacids in cats compared to dogs and most dosages used in cats have been extrapolated form those used in dogs .
Adverse Effects of Antacids The expected adverse effects of chronic acid suppressant administration in dogs and cats have largely been extrapolated from that described in humans . Cobalamin deficiency , diarrhoea , Clostridium difficile infection , increased risk of hospital-acquired pneumonia and increased risk of fractures in geriatric people are the most commonly described side effects 17 .
Diarrhoea is the most common adverse effect reported in association with proton pump inhibitor administration in dogs but does not appear to be common in cats 18 . The possible effects of proton vet360
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