The mechanism of protection by sucralfate against gastric mucosal injury induced by ethanol was investigated. The experiments in vivo were conducted with groups of rats with and without indomethacin pretreatment, and the animals received sucralfate followed by ethanol. In the in vitro experiments, gastric mucosa was cultured in the presence of sucralfate, ethanol, or both. The in vivo experiments revealed that ethanol caused extensive gastric hemorrhagic lesions which were significantly reduced following sucralfate pretreatment and that this effect of sucralfate was not prevented by indomethacin. The data with gastric mucosal culture demonstrated that ethanol caused a 24% decrease in mucin synthesis, while mucin synthesis in the presence of sucralfate increased by 32%. This increase was accompanied by the enhanced metabolism of mucosal phosphoinositides, as reflected by a 22% decrease in PI, 1,2-fold increase in IP1 and 3.4-fold increase in IP3. In contrast, ethanol, caused 1.5-fold increase in IP1 and PIP2, and 35% decrease in PIP, 47% decrease in IP2 and 38% decrease in IP3. However, when the mucosal culture was carried out in the presence of both sucralfate and ethanol, the detrimental changes evoked by ethanol in mucin synthesis were prevented. The results suggest that the mucosal protective action of sucralfate involves the metabolism of phosphoinositide-derived messenger molecules.