The Role of the Acid Pocket in Gastroesophageal Reflux Disease

Mitchell, David; Derakhshan, Mohammad H.; Robertson, Elaine V.; McColl, Kenneth E.L.

doi:10.1097/mcg.0000000000000439

Cited by 30 publications

(14 citation statements)

References 59 publications

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“…Symptomatic breakthrough in non‐erosive reflux disease (NERD) occurs primarily with regard to pathological postprandial reflux . In untreated individuals, the “acid pocket” forms on top of food‐buffered gastric contents and acts as a highly acidic source of postprandial reflux . A postprandial layer of gastric secretion also exists in PPI‐treated patients; it is less acidic than the acid pocket (~pH 3.9 vs ~0.9) but remains the source of reflux after meals …”

Section: Introductionmentioning

confidence: 99%

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Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Coyle

Crawford

Wilkinson

et al. 2017

Aliment Pharmacol Ther

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Section: Introductionmentioning

confidence: 99%

“…Alginates are interesting candidates for use as an add‐on therapy as they act in a complementary way to PPIs by directly capping postprandial reflux . The alginate‐antacid formulation, Gaviscon Double Action (Gaviscon DA; RB, Slough, UK), has been shown to co‐localise and eliminate the acid pocket in GERD patients .…”

Section: Introductionmentioning

confidence: 99%

Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Coyle

Crawford

Wilkinson

et al. 2017

Aliment Pharmacol Ther

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show abstract

“…52 The acid pocket, which is detected more frequently after large fatty or spicy meals, is longer in patients with GERD and in those with hiatal hernia (HH). 53 While in patients with a small HH, the acid pocket is located below the diaphragm, it is above the diaphragm in 40% of those patients with a large hernia. 53 3D echoplanar magnetic resonance imaging clearly shows, after the intake of an alginate-containing formulation (namely Gaviscon TM Advance), the development of a raft at the air-meal interface after a liquid meal and formation of a clot between the gastroesophageal junction and solid meal, exactly where the acid pocket would be located.…”

Section: Alginate-containing Formulations: Merely Barrier Drugs or Mumentioning

confidence: 99%

Gastrointestinal pharmacology: practical tips for the esophagologist

Scarpignato

Sloan²,

Wang

et al. 2020

Annals of the New York Academy of Sciences

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Gastroesophageal reflux disease (GERD) is primarily a motor disorder, and its pathogenesis is multifactorial. As a consequence, treatment should be able to address the underlying pathophysiology. Proton pump inhibitors (PPIs) are the mainstay of medical therapy for GERD, but these drugs only provide the control of symptoms and lesions without curing the disease. However, continuous acid suppression with PPIs is recommended for patients with Barrett's esophagus because of their potential chemopreventive effects. In addition to the antisecretory activity, these compounds display several pharmacological properties, often overlooked in clinical practice. PPIs can indeed affect gastric motility, exert a mucosal protective effect, and an antioxidant, anti‐inflammatory, and antineoplastic activity, also protecting cancer cells from developing chemo‐ or radiotherapeutic resistance. Even in the third millennium, current pharmacologic approaches to address GERD are limited. Reflux inhibitors represent a promise unfulfilled, effective and safe prokinetics are lacking, and antidepressants, despite being effective in selected patients, give rise to adverse events in a large proportion of them. While waiting for new drug classes (like potassium‐competitive acid blockers), reassessing old drugs (namely alginate‐containing formulations), and paving the new avenue of esophageal mucosal protection are, at the present time, the only reliable alternatives to acid suppression.

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“…The acid pocket is a short zone of unbuffered highly acidic gastric juice that accumulates in the proximal stomach after meals. Serving as the source of acid reflux, the acid pocket increases the propensity for acid reflux by all conventional mechanisms, such as TLESR and hiatus hernia, and has been considered as an important cause of GERD [25,26]. Alginate is an anionic polysaccharide occurring naturally in brown algae and has a unique property in the treatment of gastric reflux by eliminating the acid pocket.…”

Section: Introductionmentioning

confidence: 99%

The Clinical Relevance of Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux in Clinical Practice

Emanuele¹,

Giada²,

GiorgioCiprandi³

2018

Esophageal Cancer and Beyond

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Gastric reflux may be considered a para-physiological event that may occur up to 50 times a day. It usually happens when gas (less commonly liquids) flow back from stomach into esophagus. However, when defense mechanisms leave, disease may progress. If the esophagus is the trigger, gastroesophageal reflux disease (GERD) emerges. The prevalence of GERD in the primary care setting seems to be even more evident when one considers that, in the United States, 4.6 million office encounters annually are primarily for GERD, whereas 9.1 million encounters include GERD in the top 3 diagnoses for the encounter. GERD constitutes also the most frequently first-listed gastrointestinal diagnosis in ambulatory care visits. In addition, the extraesophageal manifestations of reflux, including LPR, asthma, and chronic cough, have been estimated to cost $5438 per patient in direct medical expenses in the first year after presentation and $13,700 for 5 years. Presently, the newest alginate compounds renowned the interest in this attracting and stimulating area. In this regard, a new medical device (Marial®), unique still now possessing the indication for both GERD and LPR, has been recently launched in the Italian market, two large surveys were conducted in Italy: RELIEF, involving 86 otolaryngologists, and EMERGE, involving 56 gastroenterologists. The aims of these surveys were: (1) to define clinical characteristics, including previous treatment, of the patients referred to consultation; (2) to evaluate the reliability of RFS, GIS, and RSI questionnaires in real-world settings, such as specialist office; and (3) to investigate the patients' perception of efficacy of the prescribed therapy, based on the best practice and considering also the new medical device Comparing the patients' perception of treatment efficacy, reduction in RSI values for each single symptom before and after a 4 week-treatment with Marial® alone or with PPI in add-on in EMERGE and RELIEF patients are reported. Marial® alone treatment induced a statistically significant higher reduction in each single symptom in RELIEF patients than in EMERGE patients, with the exception of heartburn, chest pain, indigestion, or stomach

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The Role of the Acid Pocket in Gastroesophageal Reflux Disease

Cited by 30 publications

References 59 publications

Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Gastrointestinal pharmacology: practical tips for the esophagologist

The Clinical Relevance of Gastroesophageal Reflux Disease and Laryngopharyngeal Reflux in Clinical Practice

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