An Alginate-Antacid Formulation Localizes to the Acid Pocket to Reduce Acid Reflux in Patients with Gastroesophageal Reflux Disease

BACKGROUND & AIMS: Alginate rafts (polysaccharide polymers that precipitate into a low-density viscous gel when they contact gastric acid) have been reported to form at the acid pocket-an unbuffered pool of acid that floats on top of ingested food and causes post-prandial acid reflux. We studied the location of an alginate formulation in relation to the acid pocket and the corresponding effects on reflux parameters and acid pocket positioning in patients with gastroesophageal reflux disease (GERD). METHODS: We randomly assigned patients with symptomatic GERD and large hiatal hernias to groups that were given either (111)In-labeled alginate-antacid (n=8; Gaviscon Double Action Liquid, Reckitt Benckiser; Hull, UK) or antacid (n=8; Antagel, Pharmachemie; Haarlem, Netherlands) after a standard meal. The relative positions of labeled alginate and acid pocket were analyzed for 2 h using scintigraphy; reflux episodes were detected using high-resolution manometry and pH-impedance monitoring. RESULTS: The alginate-antacid label localized to the acid pocket. The number of acid reflux episodes was significantly reduced in patients receiving alginate-antacid (3.5; range, 0-6.5; P=.03) compared with those receiving antacid (15; range, 5-20), whereas time to acid reflux was significantly increased in patients receiving alginate-antacid (63 min; range, 23-92) vs those receiving antacid (14 min; range, 9-23; P=.01). The acid pocket was located below the diaphragm in 71% of patients given alginate-antacid vs 21% of those given antacid (P=0.08). There was an inverse correlation between a sub-diaphragm position of the acid pocket and acid reflux (r= -0.76; P<.001). CONCLUSIONS: In a study of 16 patients with GERD, we observed that the alginate-antacid raft localizes to the post-prandial acid pocket and displaces it below the diaphragm to reduce post-prandial acid reflux. These findings indicate the importance of the acid pocket in GERD pathogenesis and establish alginate-antacid as an appropriate therapy for post-prandial acid reflux. (www.trialregister.nl: NTR3602).

Publication year:2013

BOF-keylabel:yes

IOF-keylabel:yes

BOF-publication weight:6

CSS-citation score:2

Authors:International

Authors from:Higher Education