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An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease.

Abstract

BACKGROUND & AIMS

Alginate rafts (polysaccharide polymers that precipitate into a low-density viscous gel when they contact gastric acid) have been reported to form at the acid pocket, an unbuffered pool of acid that floats on top of ingested food and causes postprandial acid reflux. We studied the location of an alginate formulation in relation to the acid pocket and the corresponding effects on reflux parameters and acid pocket positioning in patients with gastroesophageal reflux disease (GERD).

METHODS

We randomly assigned patients with symptomatic GERD and large hiatal hernias to groups who were given either (111)In-labeled alginate-antacid (n = 8, Gaviscon Double Action Liquid) or antacid (n = 8, Antagel) after a standard meal. The relative positions of labeled alginate and acid pocket were analyzed for 2 hours by using scintigraphy; reflux episodes were detected by using high-resolution manometry and pH-impedance monitoring.

RESULTS

The alginate-antacid label localized to the acid pocket. The number of acid reflux episodes was significantly reduced in patients receiving alginate-antacid (3.5; range, 0-6.5; P = .03) compared with those receiving antacid (15; range, 5-20), whereas time to acid reflux was significantly increased in patients receiving alginate-antacid (63 minutes; range, 23-92) vs those receiving antacid (14 minutes; range, 9-23; P = .01). The acid pocket was located below the diaphragm in 71% of patients given alginate-antacid vs 21% of those given antacid (P = .08). There was an inverse correlation between a subdiaphragm position of the acid pocket and acid reflux (r = -0.76, P < .001).

CONCLUSIONS

In a study of 16 patients with GERD, we observed that the alginate-antacid raft localizes to the postprandial acid pocket and displaces it below the diaphragm to reduce postprandial acid reflux. These findings indicate the importance of the acid pocket in GERD pathogenesis and establish alginate-antacid as an appropriate therapy for postprandial acid reflux.

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  • Publisher Full Text
  • Authors+Show Affiliations

    ,

    Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, the Netherlands.

    , , ,

    Source

    MeSH

    Alginates
    Antacids
    Drug Carriers
    Electric Impedance
    Gastroesophageal Reflux
    Glucuronic Acid
    Hexuronic Acids
    Humans
    Manometry
    Radionuclide Imaging
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Randomized Controlled Trial

    Language

    eng

    PubMed ID

    23669304

    Citation

    Rohof, Wout O., et al. "An Alginate-antacid Formulation Localizes to the Acid Pocket to Reduce Acid Reflux in Patients With Gastroesophageal Reflux Disease." Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, vol. 11, no. 12, 2013, pp. 1585-91; quiz e90.
    Rohof WO, Bennink RJ, Smout AJ, et al. An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol. 2013;11(12):1585-91; quiz e90.
    Rohof, W. O., Bennink, R. J., Smout, A. J., Thomas, E., & Boeckxstaens, G. E. (2013). An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. Clinical Gastroenterology and Hepatology : the Official Clinical Practice Journal of the American Gastroenterological Association, 11(12), pp. 1585-91; quiz e90. doi:10.1016/j.cgh.2013.04.046.
    Rohof WO, et al. An Alginate-antacid Formulation Localizes to the Acid Pocket to Reduce Acid Reflux in Patients With Gastroesophageal Reflux Disease. Clin Gastroenterol Hepatol. 2013;11(12):1585-91; quiz e90. PubMed PMID: 23669304.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - An alginate-antacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. AU - Rohof,Wout O, AU - Bennink,Roel J, AU - Smout,Andre J P M, AU - Thomas,Edward, AU - Boeckxstaens,Guy E, Y1 - 2013/05/10/ PY - 2013/01/23/received PY - 2013/04/24/revised PY - 2013/04/25/accepted PY - 2013/5/15/entrez PY - 2013/5/15/pubmed PY - 2014/7/8/medline KW - Clinical Trial KW - EGJ KW - Esophagus KW - GERD KW - HRM KW - Heartburn KW - LES KW - PPI KW - esophagogastric junction KW - gastroesophageal reflux disease KW - high-resolution manometry KW - lower esophageal sphincter KW - proton pump inhibitor SP - 1585-91; quiz e90 JF - Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association JO - Clin. Gastroenterol. Hepatol. VL - 11 IS - 12 N2 - BACKGROUND & AIMS: Alginate rafts (polysaccharide polymers that precipitate into a low-density viscous gel when they contact gastric acid) have been reported to form at the acid pocket, an unbuffered pool of acid that floats on top of ingested food and causes postprandial acid reflux. We studied the location of an alginate formulation in relation to the acid pocket and the corresponding effects on reflux parameters and acid pocket positioning in patients with gastroesophageal reflux disease (GERD). METHODS: We randomly assigned patients with symptomatic GERD and large hiatal hernias to groups who were given either (111)In-labeled alginate-antacid (n = 8, Gaviscon Double Action Liquid) or antacid (n = 8, Antagel) after a standard meal. The relative positions of labeled alginate and acid pocket were analyzed for 2 hours by using scintigraphy; reflux episodes were detected by using high-resolution manometry and pH-impedance monitoring. RESULTS: The alginate-antacid label localized to the acid pocket. The number of acid reflux episodes was significantly reduced in patients receiving alginate-antacid (3.5; range, 0-6.5; P = .03) compared with those receiving antacid (15; range, 5-20), whereas time to acid reflux was significantly increased in patients receiving alginate-antacid (63 minutes; range, 23-92) vs those receiving antacid (14 minutes; range, 9-23; P = .01). The acid pocket was located below the diaphragm in 71% of patients given alginate-antacid vs 21% of those given antacid (P = .08). There was an inverse correlation between a subdiaphragm position of the acid pocket and acid reflux (r = -0.76, P < .001). CONCLUSIONS: In a study of 16 patients with GERD, we observed that the alginate-antacid raft localizes to the postprandial acid pocket and displaces it below the diaphragm to reduce postprandial acid reflux. These findings indicate the importance of the acid pocket in GERD pathogenesis and establish alginate-antacid as an appropriate therapy for postprandial acid reflux. SN - 1542-7714 UR - https://www.unboundmedicine.com/medline/citation/23669304/full_citation L2 - https://linkinghub.elsevier.com/retrieve/pii/S1542-3565(13)00621-6 DB - PRIME DP - Unbound Medicine ER -