Onset of acid-neutralizing action of a calcium/magnesium carbonate-based antacid using an artificial stomach model: an in vitro evaluation

Abstract

Background Calcium carbonate antacids are potent over-the-counter antacids, made more effective by adding magnesium carbonate (as in Rennie, Bayer). However, published studies on their onset of action are scarce. Therefore, we carried out an in vitro study comparing Rennie and placebo under simulated conditions of the human stomach (artificial stomach model) to reconfirm the onset of action of Rennie. Methods The validated Simulator of the Human Intestinal Microbial Ecosystem apparatus (SHIME, ProDigest, Belgium) was used, comprising five reactors simulating different parts of the human gastrointestinal tract. Both Rennie and placebo were dosed at two tablets per incubation over six independent, 2-h stomach incubations each. Primary objectives: to evaluate the time required to achieve pH 3.0, 3.5, 4.0 and 4.5, as well as the maximum pH reached. Secondary objective: to evaluate pepsin activity over the entire 2-h gastric incubation. Results After addition of Rennie, the gastric medium reached a pH of 3.0 within 40 s. The maximum pH of 5.24 was maintained for almost 10 min. In contrast, the maximum pH with placebo was 1.28 during the entire gastric simulation. Furthermore, Rennie strongly reduced the activity of mucosa-damaging pepsin during the period of increased pH. With placebo, the lower pH resulted in consistently high loads of digested peptides, reflecting the high cumulative and instantaneous pepsin activity. Conclusions New data is a critical component in informed decision making. Our data confirm the high efficacy and fast onset of acid-neutralizing action of Rennie, which begins to work within seconds.

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“…The steps required for food uptake and digestion in the stomach and small intestine are simulated by the first two reactors, whereas the other three compartments represent the ascending, transverse, and descending colon, respectively. 76 TIM-1 is a computer-controlled, dynamic, multi-compartmental system that simulates all physiological processes of the human upper gastrointestinal tract (lumen of the stomach and small intestine). 74 It offers relatively easy manipulation, reproducibility (no biological variation) and, most importantly, accuracy compared with in vivo techniques.…”

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“…58 It should be noted that calcium carbonate is used in the modern medicine as an antacid to relieve heartburn, acid indigestion, and stomach upset. 59 A. vera is also reported to reduce the symptoms of gastroesophageal reflux disease. 60 However, no correlation between A. vera and calcium carbonate has been experimentally demonstrated for the medical use of Shankh Bhasma .…”

Assessment of the Acid Neutralizing Capacity and Other Properties of Antacid Formulations Marketed in the Gaza Strip

“…All samples showed ability to bring pH above 3.5 and maintain the pH above 3.5 for 43 and up to 90 minutes (Table 4). All samples brought pH to 3.5 and more when mixed with HCl and stand for 10 minutes (Voropaiev & Nock, 2021). Additional time was required for A1 and A3, which required more time for neutralization reaction onset.…”

“…Although in vitro studies can simulate the in vivo conditions, several factors such as gastric emptying rate, interactions between food and medications, and gastric juice secretion rate affect antacid function (Richa et al, 1997, Lirazan et al, 2018, Voropaiev& Nock, 2021. These findings strongly urge the examination of different batches of the same formulations.…”