Gaviscon Double Action Liquid (antacid &amp; alginate) is more effective than antacid in controlling post‐prandial oesophageal acid exposure in <scp>GERD</scp> patients: a double‐blind crossover study

Ruigh, Annemijn de; Roman, Sabine; Chen, J.; Pandolfino, John E.; Kahrilas, Peter J.

doi:10.1111/apt.12857

Cited by 77 publications

(56 citation statements)

References 19 publications

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“…An alginate gastric raft may be able to reduce the number of acid reflux episodes (4,8,19), with this property being considered as due to the viscous barrier surface tension reducing reflux through the gastroesophageal junction. However, recent evidence suggests that the ability of the alginate raft to reduce the number of reflux episodes may be limited (6). A second important physical property of alginate rafts appears to be their ability to abolish or displace the postprandial "acid pocket" in patients with symptomatic GERD (15).…”

mentioning

confidence: 99%

Topical protection of human esophageal mucosal integrity

Woodland

Batista‐Lima

Lee

et al. 2015

American Journal of Physiology-Gastrointestinal and Liver Physi

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Patients with nonerosive reflux disease exhibit impaired esophageal mucosal integrity, which may underlie enhanced reflux perception. In vitro topical application of an alginate solution can protect mucosal biopsies against acid-induced changes in transepithelial electrical resistance (TER). We aimed to confirm this finding in a second model using 3D cell cultures and to assess prolonged protection in a biopsy model. We assessed the protective effect of a topically applied alginate solution 1 h after application. 3D cell cultures were grown by using an air-liquid interface and were studied in Ussing chambers. The apical surface was "protected" with 200 μl of either alginate or viscous control or was unprotected. The tissue was exposed to pH 3 + bile acid solution for 30 min and TER change was calculated. Distal esophageal mucosal biopsies were taken from 12 patients and studied in Ussing chambers. The biopsies were coated with either alginate or viscous control solution. The biopsies were then bathed in pH 7.4 solution for 1 h. The luminal chamber solution was replaced with pH 2 solution for 30 min. Percentage changes in TER were recorded. In five biopsies fluorescein-labeled alginate solution was used to allow immunohistological localization of the alginate after 1 h. In the cell culture model, alginate solution protected tissue against acid-induced change in TER. In biopsies, 60 min after protection with alginate solution, the acidic exposure caused a -8.3 ± 2.2% change in TER compared with -25.1 ± 4.5% change after protection with the viscous control (P < 0.05). Labeled alginate could be seen coating the luminal surface in all cases. In vitro, alginate solutions can adhere to the esophageal mucosa for up to 1 h and exert a topical protectant effect. Durable topical protectants can be further explored as first-line/add-on therapies for gastroesophageal reflux disease.

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mentioning

confidence: 99%

Topical protection of human esophageal mucosal integrity

Woodland

Batista‐Lima

Lee

et al. 2015

American Journal of Physiology-Gastrointestinal and Liver Physi

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“…The parameters measured included acid exposure to the esophagus, number of reflux events, intensity of reflux, reflux mechanism, and symptoms. Both formulations resulted in a similarity number and spatial distribution of reflux events but GDA was more effective than antacid in minimizing the exposure the esophagus to acid . A further study, the role of GDA in the reduction of heartburn, acid regurgitation, and dyspepsia in patients experiencing mild to moderate GORD was assessed.…”

Section: Resultsmentioning

confidence: 99%

Raft‐forming polysaccharides for the treatment of gastroesophageal reflux disease (GORD): Systematic review

Yousaf

Nirwan

Smith

et al. 2019

J of Applied Polymer Sci

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Gastroesophageal reflux disease (GORD) is a common condition induced by unwarranted reflux of gastric and duodenal contents into the esophagus, and insufficient clearance of refluxate from it. Pharmaceutical formulations possessing raft‐forming capability offers an excellent alternative to conventional treatment options to treat uncomplicated GORD. These formulations typically contain a polymer, which performs distinctively upon contact with gastric acid and develops a foam‐like structure that can float on gastric contents. This review aims to feature research articles and patents that cover this topic. After undergoing a standardized literature search following preferred reporting items for systematic reviews and meta‐analyses guidelines, we have included 38 research articles and 18 patents describing the role of raft‐forming polymers in the treatment of GORD. This is a comprehensive review of formulation/testing of raft‐forming polymers. As expected, the majority of the studies focused on alginate; however, fewer studies have reported the use of pectin, xanthan gum, and raw psyllium fibers (husk). Moreover, it can be concluded from this comprehensive systematic review that a detailed characterization of raft‐forming formulations, type, and concentration of used active and inactive materials and different formulations factors are essential for the development of successful anti‐reflux raft‐forming formulations. © 2019 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2019, 136, 48012.

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“…Furthermore, dual action antacids (antacid with alginate) have been shown to be superior to antacids alone in reducing postprandial esophageal acid exposure in GERD patients [9].…”

Section: Hpimentioning

confidence: 99%

A Favorable Response of Dysplastic Barrett’s Refractory to Ablation Therapy Only after Initiation of an Alginate Solution as Add-on Therapy

Brodie¹,

Elias²,

Khalaf³

et al. 2017

J Gastrointest Dig Syst

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Alginates have been shown not only to be beneficial in their relief of symptomatic post-prandial gastroesophageal reflux, but there is also evidence that they may inhibit reflux, including bile acids and pepsin, and in turn attenuate and even prevent the activation and up-regulation of molecules associated with the development of metaplasia and cancer of the esophagus. Here we present the case of a patient with Barrett's esophagus with high-grade dysplasia (HGD) which was initially unresponsive to endoscopic radiofrequency ablation therapy and cryotherapy for highgrade dysplasia. Following initiation of therapy with an alginate solution in addition to twice daily proton pump inhibitor (PPI) therapy, the patient showed a favorable response and eventual complete eradication of his dysplastic Barrett's. The patient's course is suggestive that the alginate solution, through reflux inhibition, prevented persistent esophageal cell changes which occur secondary to gastric and bile acid exposure, thus allowing development of neosquamous epithelium. This case is intriguing with regard to the role of alginates in creating a favorable environment for esophageal healing when treating Barrett's esophagus with high-grade dysplasia. Keywords: Gastroesophageal reflux; Endoscopy; Proton pump inhibitor; Hernia Case Study HPIA.H. is a 46 year old male with history of hiatal hernia and gastroesophageal reflux disease (GERD) who presented to our tertiary referral center for management of long segment dysplastic Barrett's esophagus with high-grade dysplasia (HGD) which had been refractory to treatment with radiofrequency ablation (RFA). The patient had undergone five rounds of RFA at an outside medical center with less than 50% improvement of his dysplastic Barrett's at the time of the fifth endoscopy. His last endoscopy prior to transfer had revealed residual dysplastic Barrett's in the lower esophagus, and biopsies showed persistent HGD. On presentation to our center, the patient reported that his acid reflux was not well-controlled despite twice daily PPI. He complained of heartburn, night time regurgitation, and nonproductive cough. Review of systems was otherwise negative for chest pain, shortness of breath, dysphagia, odynophagia, weight loss, abdominal pain, nausea, vomiting, or other complaints. Treatment course: After a long discussion with the therapeutic endoscopy team, options other than RFA such as endoscopic mucosal resection and cryotherapy were discussed. Given the distribution, anatomy and flat nature of his Barrett's esophagus, cryotherapy was started and he began receiving treatments every two months starting in July 2014. After the first three treatments, there was minimal endoscopic evidence of improvement in the surface area of Barrett's epithelium with less than 50% improvement, so ablation exposure times were increased from 20 to 30 seconds.This still resulted in only mild improvement in appearance of his Barrett's after a total of six cryotherapy treatment sessions. Because of the lack of response, ma...

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Gaviscon Double Action Liquid (antacid & alginate) is more effective than antacid in controlling post‐prandial oesophageal acid exposure in GERD patients: a double‐blind crossover study

Cited by 77 publications

References 19 publications

Topical protection of human esophageal mucosal integrity

Topical protection of human esophageal mucosal integrity

Raft‐forming polysaccharides for the treatment of gastroesophageal reflux disease (GORD): Systematic review

A Favorable Response of Dysplastic Barrett’s Refractory to Ablation Therapy Only after Initiation of an Alginate Solution as Add-on Therapy

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