Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis

Abstract

In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with nonerosive reflux disease or atypical GERD symptoms, acid-suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. This study performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD. PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs), or PPIs for the treatment of GERD symptoms. Additional studies were identified through a bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effect models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.

Double‐blind, placebo‐controlled study with alginate suspension for laryngopharyngeal reflux disease

“…There were clinical studies, reviews, and metaanalyses indicating that alginates are more effective than placebo or antacids for treating GERD. [10][11][12] However, few studies have investigated whether Alginos (TTY Biopharm Co. Ltd.) could be used for treating LPRD. McGlashan et al conducted a pilot study on liquid alginate suspension (Gaviscon Advance, Gaviscon, Slough, U.K.) and showed statistically significant decreases in the RSI and RFS with profound placebo effects.…”

Alginates in the Treatment of Gastroesophageal Reflux Disease

“…В ранее опубликованных работах существенное облегчение симптомов рефлюкса на фоне применения альгинатов отмечалось у 74-81% больных [33]. В 2017 г. были опубликованы систематический обзор и метаанализ результатов рандомизированных исследований сравнительной эффективности альгинатов, плацебо, антацидов, антагонистов гистаминовых рецепторов 2-го типа и ИПП при неэрозивной ГЭРБ (14 исследований с участием 2095 пациентов) [34]. Исследователи оценивали ответ на терапию, определяемый либо как полное исчезновение, либо как значимое уменьшение выраженности типичных симптомов.…”

“…При сравнении эффективности альгинатов с таковой ИПП и Н2блокаторов преимущество первых не установлено (относительный риск (ОР) 0,58; 95% ДИ 0, 22), но отмечались достоверно значимые отличия (I 2 = 82%; p < 0,001). Результаты исследований, опубликованных за последние пять лет, продемонстрировали меньшую разницу между режимами терапии (ОР 0,88; 95% ДИ 0,61-1,26) без статистически значимых отличий (I 2 = 0%; p = 37) [34]. Таким образом, подтверждена эффективность альгинатов при лечении неэрозивной ГЭРБ, их преимущество перед плацебо и антацидами, что позволяет рассматривать альгинаты в качестве стартовой терапии у пациентов с умеренными симптомами ГЭРБ, для которых стойкое подавление кислотопродукции либо нежелательно, либо нецелесообразно.…”

Role of Alginates Combined with Natural Extracts to Prevent the Gastric Acid-Related Damage

“…A new group of widely used molecules includes alginates, a polymer of alginic acid derived from the cell wall of various brown algae. Alginate-based compounds have been available for several decades [29] and are listed as inactive ingredients with a substantial and independent benefit from alginate formulation [29]. Recently, there is a new growing interest in alginates as a therapy for GERD, including patients with continued symptoms despite acid suppression therapy [30].…”