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.
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.
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.
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