Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add‐on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor

Reimer, Christina; Lødrup, Anders Bergh; Smith, Gary B.; Wilkinson, Joanne; Bytzer, Peter

doi:10.1111/apt.13567

Cited by 83 publications

(65 citation statements)

References 35 publications

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“…Published after our literature search, a RCT reported symptomatic improvement in PPINR at 7 days treated with adjunctive Gaviscon, an alginate formulation that forms a protective raft over the esophageal mucosa for 7 days. 69 Tegaserod is a novel prokinetic that is currently being studied as an adjunctive agent for PPINR, though the results of the trial are yet to be published. 70 Lastly, vonoprazan is a novel potassium-competitive acid blocker that has demonstrated more potent and sustained acid suppressive effects than the PPIs LAN, ESO, and RBZ.…”

Section: Discussionmentioning

confidence: 99%

A review of medical therapy for proton pump inhibitor nonresponsive gastroesophageal reflux disease

Hillman

Yadlapati

Thuluvath

et al. 2017

Diseases of the Esophagus

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Introduction Up to 40% of patients report persistent gastroesophageal reflux disease (GERD) symptoms despite proton pump inhibitor (PPI) therapy. This review outlines the evidence for medical therapy for PPI non-responsive GERD. Materials and Methods A literature search for GERD therapies from 2005–2015 in PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and the Cochrane Database of Systematic Reviews identified unique 2928 citations. Of those, 40 unique articles specific to the impact of PPI metabolizer genotype on PPI response and the use adjunctive medical therapies were identified. Results Thirteen articles reported impacts on CYP genotypes on PPI metabolism demonstrating lower endoscopic healing rates in extensive metabolizers; however, outcomes across genotypes were more uniform with more CYP independent PPIs rabeprazole and esomeprazole. Twenty-seven publications on 11 adjunctive medications showed mixed results for adjunctive therapies including nocturnal histamine-2 receptor antagonists, promotility agents, transient lower esophageal sphincter relaxation inhibitors, and mucosal protective agents. Discussion Utilizing PPI metabolizer genotype or switching to a CYP2C19 independent PPI is a simple and conservative measure that may be useful in the setting of incomplete acid suppression. The use of adjunctive medications can be considered particularly when the physiologic mechanism for PPI non-response is suspected. Future studies using adjunctive medications with improved study design and patient enrollment are needed to better delineate medical management options before proceeding to anti-reflux interventions.

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Section: Discussionmentioning

confidence: 99%

A review of medical therapy for proton pump inhibitor nonresponsive gastroesophageal reflux disease

Hillman

Yadlapati

Thuluvath

et al. 2017

Diseases of the Esophagus

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“…The number of reflux events at night also decreased remarkably with GA treatment. This study concluded that inclusion of GA in the treatment regime of patients receiving PPI therapy had further reduced the burden of reflux symptoms . Alecci et al .…”

Section: Resultsmentioning

confidence: 75%

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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“…Theoretically, the acid pocket would be an ideal target for this compound since alginates accumulate just below the esophagogastric junction creating a foam layer above the gastric content. Preliminary studies in patients with residual symptoms during once-daily PPI therapy have been promising: the alginate preparation as an add-on treatment to PPI was superior to placebo in reducing break-through symptoms [23]. More recent studies with larger numbers of patients have, however, produced conflicting results.…”

Section: Role Of the Acid Pocketmentioning

confidence: 99%

Medical Therapy of Gastroesophageal Reflux Disease Beyond Proton Pump Inhibitors: Where Are We Heading

Koop

2018

Visc Med

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Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms persist in a substantial number of patients. Therefore, treatment strategies beyond PPI are urgently required. One such strategy may involve more reliable acid suppression, e.g., with new acid inhibitory drugs. Furthermore, the rapid appearance of an acidic compartment in the proximal stomach after a meal, which is largely responsible for postprandial heartburn, requires a specific kind of therapy in addition to PPI which still needs to be established. Pharmacological augmentation of the lower esophageal sphincter may represent another approach to diminish reflux, but the clinical efficacy of compounds tested so far is limited. Altered e-sophageal perception represents a major component involved in the generation of reflux symptoms, particularly in non-erosive reflux disease, but effective pharmacological intervention is largely lacking. Presumed reflux-induced respiratory symptoms (cough, laryngitis, etc.) in the absence of typical esophageal symptoms (e.g., heartburn) remain a hot topic, but recent research points towards a hypersensitivity syndrome and only a minor role of gastroesophageal reflux. Treatment options for this condition are still pending.

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Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add‐on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor

Abstract: In patients with residual reflux symptoms despite PPI treatment, adding an alginate offers additional decrease in the burden of reflux symptoms (EudraCT/IND Number: 2011-005486-21).

Cited by 83 publications

References 35 publications

A review of medical therapy for proton pump inhibitor nonresponsive gastroesophageal reflux disease

A review of medical therapy for proton pump inhibitor nonresponsive gastroesophageal reflux disease

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

Medical Therapy of Gastroesophageal Reflux Disease Beyond Proton Pump Inhibitors: Where Are We Heading

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