Brief Article
Copyright ©2013 Baishideng. All rights reserved.
World J Transl Med. Aug 12, 2013; 2(2): 13-21
Published online Aug 12, 2013. doi: 10.5528/wjtm.v2.i2.13
High-potency sucralfate prevents and rapidly reverses chemo-radiation mucositis in a patient with stage 4b head and neck cancer
Ricky W McCullough
Ricky W McCullough, Center for Translational Medicine Research, Mueller Medical International LLC, Foster, RI 02825, United States
Ricky W McCullough, Department of Emergency Medicine, Roger Williams Medical Center, Boston University School of Medicine Teaching Hospital, Boston, MA 02118, United States
Ricky W McCullough, Department of Medicine, Veterans Administration Medical Center, Warren P Alpert Brown University School of Medicine Teaching Hospital, Providence, RI 02904, United States
Author contributions: McCullough RW is the sole contributor to this paper.
Supported by Translation Medicine Research Compassionate Use Program of MMI, No. 2006-001; Data collection was funded as part of Mueller Medical International LLC research on polyanionic saccharides as in-vivo surface active immuno-modulating agents for epithelial mediated processes at its Center for Translational Medicine Research in Foster Rhode Island
Correspondence to: Ricky W McCullough, MD, MSc, Center for Translational Medicine Research, Mueller Medical International LLC, 830 Chaulkstone Avenue, Box 169, Foster, RI 02825, United States. glencopelph@aol.com
Telephone: +1-401-3976203 Fax: +1-401-3978559
Received: August 27, 2012
Revised: March 24, 2013
Accepted: April 27, 2013
Published online: August 12, 2013
Abstract

AIM: To study usefulness of high-potency sucralfate (HPS) in a patient with chemoradiation mucositis and discuss its mechanism of action.

METHODS: HPS, a non-covalently cross-link of sucralfate, cations and bidentate anionic chelators, has a maintains a surface concentration of sucralfate 3 h following administration that is 7-23 fold that possible with standard-potency sucralfate. The accelerated mucosal healing and pain alleviation of HPS in patients with erosive esophageal reflux, prompted its use in this patient with chemoradiation mucositis of the oropharynx and alimentary tract. A literature-based review of the immuno-modulatory effects of sucralfate is discussed.

RESULTS: Within 48 h of intervention: (1) there was complete disappearance of oral mucositis lesions; tenderness with (2) patient-reported disappearance of pain, nausea and diarrhea; patient required (3) no opiate analgesia and (4) no tube-feeding supplements to regular diet. Dysgeusia and xerostomia persisted. A modified Naranjo Questionnaire score of 10 supported the likelihood that HPS intervention caused the observed clinical effects. No adverse reactions noted.

CONCLUSION: In this patient HPS was useful to treat chemo-radiation mucositis of the oropharynx and alimentary tract. HPS may directly or indirectly facilitate an immunomodulatory mechanism involving accelerated growth factor activation, which may be a new target for therapeutic intervention in such patients.

Keywords: Sucralfate, Mucositis, Chemoradiation, Immuno-modulation, Cytokines, Intra-epithelial lymphocytes, Growth factors

Core tip: Mucositis is a debilitating and costly consequence of chemo-radiation. Most mucositis treatments are palliative. Conversely, high-potency sucralfate (HPS) may be definitive. Patients with stage 4b head neck cancer, at high risk for developing mucositis, require gastrostomy tubes as an alternative to oral feeding. The use of HPS in this cancer patient prevented mucositis, allowing continuance of standard oral diet. Midway through chemo-radiation, though noncompliant discontinuation of HPS, by patient led to the emergence oral and alimentary mucositis, 2 d following resumption of HPS, mucositis disappeared, a normal oral diet was maintained and no analgesia was required.