Duration of adhesion of swallowed alginates to distal oesophageal mucosa: implications for topical therapy of oesophageal diseases

Sonmez, Shirley; Coyle, Cathal; Sifrim, Daniel; Woodland, Philip

doi:10.1111/apt.15884

Cited by 12 publications

(14 citation statements)

References 37 publications

(40 reference statements)

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“…52,53 They act to neutralise and displace the source of postprandial acid reflux (the acid pocket) 54 and have bioadhesive properties, allowing them to coat the oesophageal F I G U R E 3 Tailoring treatment and support for reflux-like symptoms according to the suspected aetiology lining thereby improving its resistance to symptom-provoking reflux constituents. 55,56 Another mucoadhesive formulation, based on hyaluronic acid-chondroitin sulphate, has also been shown to improve symptoms in patients partially responding to PPIs. 57 A number of small studies suggest that increasing lower oesophageal sphincter (LOS) pressure with diaphragmatic breathing exercises may also be a useful adjunct to pharmacological therapy.…”

Section: Ppi and Adjunct Therapiesmentioning

confidence: 99%

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

Hungin

Scarpignato

Keefer

et al. 2022

Aliment Pharmacol Ther

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Summary Background Despite widespread adoption of potent acid suppression treatment with proton pump inhibitors (PPI) for reflux‐like symptoms, persistent symptoms are commonly reported in primary care and community studies. Aims This multidisciplinary review critically evaluates how the management of reflux‐like symptoms could better reflect their multifactorial pathophysiology. Methods A panel of experts (from general practice, gastroenterology and gastropsychology) attended a series of workshops to review current management and propose a framework for the provision of more individualised care. Results It was agreed that the perceptual (as well as the physiological) causes of reflux‐like symptoms should be considered at the start of management, not as a last resort when all else has failed. A short course of PPI is a pragmatic approach to address reflux‐like symptoms, but equally important is counselling about the gut‐brain axis and provision of symptom‐specific behavioural interventions for those who show signs of somatisation, hypervigilance or co‐existing disorders of gut‐brain interaction. Other low‐harm interventions such as lifestyle and dietary advice, should also be better integrated into care at an early stage. Multidisciplinary care management programmes (including dietary, weight loss, exercise and behavioural intervention) should be developed to promote greater self‐management and take advantage of the general shift toward the use of remotely accessed health care resources. Conclusions Management of reflux‐like symptoms should be adapted to reflect the advances in knowledge about the multifactorial aetiology of these symptoms, addressing both acid‐related and behavioural components early in management. The time has come to treat the patient, not the “disease”.

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Section: Ppi and Adjunct Therapiesmentioning

confidence: 99%

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

Hungin

Scarpignato

Keefer

et al. 2022

Aliment Pharmacol Ther

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“…Among the few compounds displaying a mucosal protective activity there is alginate, which was found to coat in vitro the luminal surface of esophageal mucosa for about 1 hour 86 and in vivo this protective effect was shown to be as long as 10 min, on average. 87 This longlasting adhesion is particularly relevant in relation to the fast transit time of liquids through the esophagus (less than 16 s), even in a supine position. 88 The association of mucosal protection with acid inhibition with PPI has been assessed in a randomized clinical trial in NERD patients and resulted to achieve a percentage of heartburn-free days significantly higher than that of PPI alone.…”

Section: Mucosal Protectionmentioning

confidence: 99%

Pharmacological Management of Gastro-Esophageal Reflux Disease: An Update of the State-of-the-Art

Savarino

Marabotto

Zentilin

et al. 2021

DDDT

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Gastro-esophageal reflux disease (GERD) is a highly prevalent, chronic disorder, whose knowledge remains limited and the management of these patients changes continuously. This review provides a summary of the most recent advancements in the pathogenesis of this disease and the new drugs introduced into the market to overcome some of the unmet needs of traditional therapies. Nowadays, the most fruitful diagnostic examinations are 24hour impedance-pH monitoring, which allows us to separate true NERD from esophageal functional disorders and high-resolution manometry, which helps to exclude the existence of motility disorders sharing the same symptoms of GERD. Proton pump inhibitors (PPIs) remain the first-choice therapy in the treatment of GERD, but a consistent proportion of these patients continue to experience symptoms despite their intake. These cases pertain mainly to the subpopulation with non-erosive reflux disease (NERD) and represent very challenging clinical situations, because it is mandatory to understand the reasons for PPI failure. The management of these difficult patients requires necessarily to test them and avoid the use of empiric treatments that are often unsuccessful, costly and potentially dangerous. Recently, several new drugs have been used to increase the defensive properties of this mucosa with promising results in randomized clinical trials.

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“…Sonmez et al have revisited alginates and shed light into a novel potential mechanism of action. 1 Alginates are natural polysaccharide polymers isolated from brown seaweed that precipitate into a low-density viscous gel on contact with acid, forming a neutral 'raft' that floats to the top of gastric contents. 2 Historically, the mechanism of action of alginates was thought to be the formation of a physical barrier to reflux; the 'raft' was thought to be of sufficient strength to block reflux.…”

Section: N V I T E D E D I T O R I a L Editorial: Alginates-navigatmentioning

confidence: 99%

Editorial: alginates—navigating beyond the ‘raft’ and acid pocket

Kia

Kahrilas

2020

Aliment Pharmacol Ther

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Duration of adhesion of swallowed alginates to distal oesophageal mucosa: implications for topical therapy of oesophageal diseases

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

Cited by 12 publications

References 37 publications

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

Review article: rethinking the “ladder” approach to reflux‐like symptom management in the era of PPI “resistance” ‐ a multidisciplinary perspective

Pharmacological Management of Gastro-Esophageal Reflux Disease: An Update of the State-of-the-Art

Editorial: alginates—navigating beyond the ‘raft’ and acid pocket

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