Sucralfate is a locally acting substance that in an acidic environment (pH < 4) reacts with hydrochloric acid in the stomach to form a cross-linking, viscous , paste-like material capable of acting as an acid buffer for as long as 6 to 8 hours after a single dose .  It also attaches to proteins on the surface of ulcers, such as albumin and fibrinogen , to form stable insoluble complexes. These complexes serve as protective barriers at the ulcer surface, preventing further damage from acid , pepsin , and bile .  In addition, sucralfate prevents back diffusion of hydrogen ions , and adsorbs both pepsin and bile acids .
Treatment of a malignant stricture of the esophagus is available but can often be disappointing. If the malignancy is determined to be small and localized, without any spread beyond the esophagus, then a surgical repair is often opted for and may, on rare occasion cure the cancer. If the tumor is not curable, then often, palliative treatments are employed. These include chemotherapy, radiation therapy, esophageal dilation, laser treatments, injections, tumor probes or placement of an esophageal stent (wire mesh tube) to keep the esophagus open.
Just how effective are PPIs? The best objective measure of the effectiveness of a heartburn remedy is its ability to reverse erosive esophagitis, a condition in which the lining of the esophagus is visibly irritated or injured. Doctors can measure this using an endoscope (a thin, flexible tube with a camera and a light attached), which is passed into the mouth and down the esophagus. Studies have shown that roughly 85% of people with erosive esophagitis are healed when they take a PPI, according to Dr. Schreiber. Far fewer people are healed of this condition with H2 blockers.