Background: Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for obese patients with GERD. Aims: To compare the efficacy of Gaviscon Advance (Reckitt Benckiser, UK) and a non-alginate antacid in post-supper suppression of the acid pocket and post-prandial reflux among obese participants. Methods: Participants underwent 48 h wireless and probe-based pH-metry recording of the acid pocket and lower oesophagus, respectively, and were randomised to single post-supper (10 pm) dose of either Gaviscon Advance or a non-alginate antacid on the second night. Primary outcomes were suppression of median pH of acid pocket and lower oesophagus, measured every 10-minutes post-supper for 1 h. Secondary outcomes were suppression of % time pH < 4 at lower oesophagus and improvement in frequency and visual analogue score (VAS) of regurgitation.Results: Of the 81 screened participants, 55 were excluded and 26 (mean age 33.5 years, males 77.8% and BMI 32.8 kg/m 2 ) were randomised to Gaviscon Advance (n = 13) or antacid (n = 13). Median pH of the acid pocket but not the lower oesophagus was suppressed with Gaviscon Advance vs antacid (all P < 0.04) Gaviscon Advance but not antacid significantly reduced in % time pH < 4, symptom frequency and VAS on day 2 vs day 1 (all P < 0.05).
Conclusions: Among obese individuals, Gaviscon Advance was superior to a nonalginate antacid in post-supper suppression of the acid pocket. (Clinical trial registration unique identifier: NCT03516188). | 1015 DERAMAN Et Al.
A 60-year-old man presented with a 2-week history of progressive dyspnea and bilateral leg edema. He had undergone a prosthetic mitral valve replacement 9 years earlier. The patient was in respiratory distress (respiratory rate 32/min, oxygen saturation 86% on air, heart rate 124/min, blood pressure 109/56 mmHg). Examination revealed bilateral lung crackles and reduced air entry with dullness to percussion and elevated jugular venous pressure. The electrocardiogram showed sinus tachycardia. A chest X-ray (CXR) (Figure 1) and bedside lung ultrasonography were performed (Figure 2A). A diagnosis of a large pleural effusion was made and urgent thoracocentesis was considered in view of the patient’s respiratory distress. A repeat ultrasonographic scan with adjusted angulation to identify the most suitable entry point for the chest drain (Figure 2B) yielded new results that led to the cancellation of the thoracocentesis.
LINKED CONTENTThis article is linked to Deraman et al and Katz and Castell papers. To view these articles, visit https://doi.org/10.1111/apt.15746 and https://doi.org/10.1111/apt.15807.
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