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Treatment of Gastrointestinal Motility Disorders in Pregnancy
- Belinda Ramirez, MD; and
- Joel Richter, MD
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IN RESPONSE:
We appreciate the comments of Dr. Nichols and stand corrected in our statement that none of the drug is absorbed. In one study [1], the amount of aluminum recovered in the urine after administration of four 1-g doses of sucralfate was less than 0.02%, similar to the amount found after ingestion of an aluminum-containing antacid. Although systemic absorption is minimal, we agree that prolonged use could result in higher systemic levels and should be considered if sucralfate is to be used during the first trimester of pregnancy.
Drs. Picca and Fiordalisi accurately point out that not all antacids are appropriate for preventing aspiration pneumonitis during obstetric anesthesia because of the possible aspiration of insoluble particulates such as aluminum and magnesium hydroxides, carbonates, and trisilicates, resulting in a severe and permanent pulmonary lesion. In contrast, the aspiration of nonparticulate antacids, such as sodium citrate, produces a less severe and transient pulmonary lesion and should be the antacid of choice in this setting [2]. Of note, however, is that antacid prophylaxis alone does not protect all obstetric patients. Better protection is probably provided by histamine-2 blockers in combination with nonparticulate antacids or with more potent agents, such as high-dose omeprazole, given the night before surgery.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
Include no more than 300 words of text, three authors, and five references
Type with double-spacing
Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright 2004 by the American College of Physicians
