Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Coyle, Cathal; Crawford, G.; Wilkinson, Joanne; Thomas, Samisha; Bytzer, Peter

doi:10.1111/apt.14064

Cited by 35 publications

(24 citation statements)

References 39 publications

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“…The results showed a significant level of suppression of reflux events in patients receiving the Gaviscon formulation compared with the placebo. The study concluded that the placebo produced no response in patients taking PPI treatment whereas Gaviscon reduced reflux episodes when given in combination with PPIs . In a recent study by Hanif and Abbas, the raft‐forming ability of a formulation containing alginates and pectin was determined; Box–Behnken design was used to determine the response surface design.…”

Section: Resultsmentioning

confidence: 99%

Raft‐forming polysaccharides for the treatment of gastroesophageal reflux disease (GORD): Systematic review

Yousaf

Nirwan

Smith

et al. 2019

J of Applied Polymer Sci

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Gastroesophageal reflux disease (GORD) is a common condition induced by unwarranted reflux of gastric and duodenal contents into the esophagus, and insufficient clearance of refluxate from it. Pharmaceutical formulations possessing raft‐forming capability offers an excellent alternative to conventional treatment options to treat uncomplicated GORD. These formulations typically contain a polymer, which performs distinctively upon contact with gastric acid and develops a foam‐like structure that can float on gastric contents. This review aims to feature research articles and patents that cover this topic. After undergoing a standardized literature search following preferred reporting items for systematic reviews and meta‐analyses guidelines, we have included 38 research articles and 18 patents describing the role of raft‐forming polymers in the treatment of GORD. This is a comprehensive review of formulation/testing of raft‐forming polymers. As expected, the majority of the studies focused on alginate; however, fewer studies have reported the use of pectin, xanthan gum, and raw psyllium fibers (husk). Moreover, it can be concluded from this comprehensive systematic review that a detailed characterization of raft‐forming formulations, type, and concentration of used active and inactive materials and different formulations factors are essential for the development of successful anti‐reflux raft‐forming formulations. © 2019 Wiley Periodicals, Inc. J. Appl. Polym. Sci. 2019, 136, 48012.

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Section: Resultsmentioning

confidence: 99%

Raft‐forming polysaccharides for the treatment of gastroesophageal reflux disease (GORD): Systematic review

Yousaf

Nirwan

Smith

et al. 2019

J of Applied Polymer Sci

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“…More recent studies with larger numbers of patients have, however, produced conflicting results. The beneficial effect of an alginate added to the PPI in the exploratory part of the study by Coyle et al [24] could not be reproduced in the confirmatory part of the trial. Thus, it remains to be established to what extent alginates may play a role in PPI-refractory postprandial heartburn; alternative strategies targeting the acid pocket need to be developed.…”

Section: Role Of the Acid Pocketmentioning

confidence: 91%

Medical Therapy of Gastroesophageal Reflux Disease Beyond Proton Pump Inhibitors: Where Are We Heading

Koop

2018

Visc Med

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Proton pump inhibitors (PPI) have greatly improved the treatment of gastroesophageal reflux disease. However, recent investigations have revealed that reflux symptoms persist in a substantial number of patients. Therefore, treatment strategies beyond PPI are urgently required. One such strategy may involve more reliable acid suppression, e.g., with new acid inhibitory drugs. Furthermore, the rapid appearance of an acidic compartment in the proximal stomach after a meal, which is largely responsible for postprandial heartburn, requires a specific kind of therapy in addition to PPI which still needs to be established. Pharmacological augmentation of the lower esophageal sphincter may represent another approach to diminish reflux, but the clinical efficacy of compounds tested so far is limited. Altered e-sophageal perception represents a major component involved in the generation of reflux symptoms, particularly in non-erosive reflux disease, but effective pharmacological intervention is largely lacking. Presumed reflux-induced respiratory symptoms (cough, laryngitis, etc.) in the absence of typical esophageal symptoms (e.g., heartburn) remain a hot topic, but recent research points towards a hypersensitivity syndrome and only a minor role of gastroesophageal reflux. Treatment options for this condition are still pending.

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“…Most alternative pharmacologic and invasive options are complementary rather than true alternatives to acid suppression and ARS. Alginates cover the acid pocket and reduce esophageal contact exposure—safety profile is excellent and these may serve a complementary role for some patients . Baclofen, a gamma amino butyric acid B receptor agonist, has been shown to reduce TLESRs and reflux episodes; however, efficacy is limited due to adverse effects and tachyphylaxis .…”

Section: Management Considerationsmentioning

confidence: 99%

“…Alginates cover the acid pocket and reduce esophageal contact exposure-safety profile is excellent and these may serve a complementary role for some patients. 119,120 Baclofen, a gamma amino butyric acid B receptor agonist, has been shown to reduce TLESRs and reflux episodes; however, efficacy is limited due to adverse effects and tachyphylaxis. [121][122][123] Prokinetics increase gastric emptying and esophageal contraction and may have modest efficacy in some patients; however, limited benefit must be weighed against medical tolerability and risk.…”

Section: Alternative Therapiesmentioning

confidence: 99%

Nonerosive reflux disease: clinical concepts

Gyawali

Azagury

Chan

et al. 2018

Annals of the New York Academy of Sciences

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Esophageal symptoms can arise from gastroesophageal reflux disease (GERD) as well as other mucosal and motor processes, structural disease, and functional esophageal syndromes. GERD is the most common esophageal disorder, but diagnosis may not be straightforward when symptoms persist despite empiric acid suppressive therapy and when mucosal erosions are not seen on endoscopy (as for nonerosive reflux disease, NERD). Esophageal physiological tests (ambulatory pH or pH-impedance monitoring and manometry) can be of value in defining abnormal reflux burden and reflux-symptom association. NERD diagnosed on the basis of abnormal reflux burden on ambulatory reflux monitoring is associated with similar symptom response from antireflux therapy for erosive esophagitis. Acid suppression is the mainstay of therapy, and antireflux surgery has a definitive role in the management of persisting symptoms attributed to NERD, especially when the esophagogastric junction is compromised. Adjunctive approaches and complementary therapy may be of additional value in management. In this review, we describe the evaluation, diagnosis, differential diagnosis, and management of NERD.

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Randomised clinical trial: addition of alginate‐antacid (Gaviscon Double Action) to proton pump inhibitor therapy in patients with breakthrough symptoms

Abstract: Adding Gaviscon to PPI reduced breakthrough GERD symptoms but a nearly equal response was observed for placebo. Response to intervention may vary according to whether symptoms are functional in origin.

Cited by 35 publications

References 39 publications

Raft‐forming polysaccharides for the treatment of gastroesophageal reflux disease (GORD): Systematic review

Raft‐forming polysaccharides for the treatment of gastroesophageal reflux disease (GORD): Systematic review

Medical Therapy of Gastroesophageal Reflux Disease Beyond Proton Pump Inhibitors: Where Are We Heading

Nonerosive reflux disease: clinical concepts

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