The mode of action of sucralfate: the 1 x 1 x 1 mechanism of action.

Of the multiple actions of sucralfate, not all are equally relevant. In fact, certain actions of the drug contribute to healing of acute ulcers or to ulcer prevention, whereas other actions are more important in accelerating the healing of gastric and duodenal ulcers. The action of sucralfate can now be defined by the '1 x 1 x 1' mechanism of action--that is, one action of sucralfate is important for acute prevention, one is relevant to both acute and chronic protection, and one is important for chronic ulcer healing. Maintenance of mucosal vascular integrity and of blood flow, which ensures rapid epithelial restitution to repair superficial defects, are the most important acute actions of sucralfate. On the other hand, increased bicarbonate and mucus secretion seem to be relevant in both acute and chronic protection of the gastroduodenal mucosa. Finally, the enhanced binding by sucralfate of fibroblast growth factor and epidermal growth factor stimulates angiogenesis, granulation tissue, and epithelization for ulcer healing. This 1 x 1 x 1 theory of the mechanism of action of sucralfate concentrates on the relevant effects of this drug (which has more than a dozen actions) and may help to elucidate the molecular mechanism of action.