The Effect of Alginate in Gastroesophageal Reflux in Infants

Abstract

BackgroundGuidelines are contradictory regarding the use of alginate in infants with persisting gastroesophageal reflux (GER). While The British National Institute for Health and Care (NICE) guidelines consider alginate as a treatment option, the guidelines of the European and North-American Societies for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN, NASPGHAN) do not recommend alginates.AimsWe assessed the efficacy of alginate to reduce GER episodes in infants.MethodsIn a prospective, observational study, we consecutively enrolled all infants referred for pH-multiple intraluminal impedance (pH-MII) recording because of persisting GER symptoms not responsive to behavior and dietetic modifications. A 48-h pH-MII was performed in all infants; a baseline recording was performed during the first 24 h while magnesium or sodium alginate was administered during the second 24 h. The primary endpoint was the difference in the total number of GER episodes per 24 h between the baseline day and the second day during which the alginate was administered. The secondary outcome was the difference in symptoms between each period. We also compared other pH-MII data from before and during alginate administration.ResultsWe recruited 43 infants (median age 68 days, range 25–306); three pH-MII tracings were excluded because of artifacts. The median number of all MII reflux episodes was significantly reduced during alginate administration (76.0 vs 69.5; p < 0.001). Crying-fussiness, cough and regurgitation episodes all significantly improved during alginate administration (p = 0.00012; p = 0.005 and p = 0.04, respectively). The following MII parameters also decreased during the alginate administration: acid (19.0 vs 14.5; p < 0.04), non-acid (52.0 vs 49.5; p < 0.004), proximal GER episodes (46.0 vs 41.4; p < 0.007), and bolus exposure index (1.9 vs 1.6; p = 0.002). At least three out of seven pH-MII parameters decreased by > 10% during the alginate period in 31/40 infants (77.5%), without a significant difference between magnesium and sodium alginate.ConclusionThese results suggest that alginate significantly decreases the number and extension of both acid and non-acid reflux episodes and associated symptoms in infants.Electronic supplementary materialThe online version of this article (10.1007/s40272-018-0314-0) contains supplementary material, which is available to authorized users.

Magnesium Alginate in Gastro-Esophageal Reflux: A Randomized Multicenter Cross-Over Study in Infants

“…Very recently, Salvatore et al demonstrated that alginate-based formulations reduced both acid and nonacid reflux episodes assessed by esophageal pH impedance and symptoms reported during the investigation in 31/40 (77%) infants with persisting GER symptoms non-responsive to behavior and diet modification [19].…”

“…[17]. We considered persistent regurgitation when I-GERQ-R was above the cut-off limit or normal (≥16), as already reported [18,19].…”

Functional Gastrointestinal Disorders in Infancy: Impact on the Health of the Infant and Family

“…Medication and investigations are not required in the management of uncomplicated regurgitation. If the infant is in a very distressed state, mainly after a feeding or between the feeds, treatment with alginate may be given a chance [23]. A survey in Italy revealed that 56% of general pediatricians prescribe proton pump inhibitors for infants with gastroesophageal reflux (GER) symptoms associated with unexplained crying and/or irritability, and 38% of the pediatricians prescribe PPI in infants with uncomplicated recurrent regurgitation and vomiting [24].…”

Gastroesophageal reflux in children: an updated review

“…Surface barrier agents work by acting as a physical barrier to prevent damage to the esophageal mucosa by refluxed gastric acid 8. Sodium alginate, a polysaccharide derived from brown seaweed, has been used in the treatment of gastroesophageal reflux disease 90,109. In the presence of gastric acid in the stomach, alginate precipitates and forms a viscous gel, thereby increasing the viscosity of feeds and reducing gastroesophageal reflux 42,45,90,110,111.…”