Sucralfate Enteral feeds

Anderson W, Weatherstone G, Veal C. Esophageal medication bezoar in a patient receiving enteral feedings and sucralfate. Am J Gastroenterol 1989 84(2) 205-6. 

Aluminium-containing antacids and sucralfate can interact with high-protein liquid enteral feeds to produce an obstructive plug. 

A number of reports describe the development of hard putty-like or creamy precipitations and encrustations that have blocked the oesophagus or stomach of patients given sucralfate with enteral feeds (Ensure Pbis Fresubin plus F or Osmolit ). Another patient developed this precipitate when treated with Isocal and sucralfate with aluminium/magnesium hydroxide. Similarly, a patient receiving Pubnocare nasogastric feed, sucralfate and aluminium hydroxide gel also developed an oesophageal be-zoar, which was analysed and found to contain components of both the drugs and the enteral feed. ... 

It seems that a bezoar (a relatively insoluble complex) forms between the protein in the enteral feeds, and the aluminium from the antacids or sucralfate (sucralfate is about 18% aluminium). It thickens when the pH falls. ... 

---