Post‐prandial reflux suppression by a raft‐forming alginate (Gaviscon Advance) compared to a simple antacid documented by magnetic resonance imaging and pH‐impedance monitoring: mechanistic assessment in healthy volunteers and randomised, controlled, double‐blind study in reflux patients. Issue 11 (18th April 2013)

• Record Type: Journal Article
• Authors: Sweis, R.; Kaufman, E.; Anggiansah, A.; Wong, T.; Dettmar, P.; Fried, M.; Schwizer, W.; Avvari, R. K.; Pal, A.; Fox, M.
• Is Part Of: Alimentary pharmacology & therapeutics. Volume 37:Issue 11(2013)
• Page Start: 1093
• Page End: 1102
• Publication Date: 2013-04-18
• Subjects: Digestive organs -- Diseases -- Treatment -- Periodicals; Digestive organs -- Effect of drugs on -- Periodicals; Gastrointestinal system -- Diseases -- Treatment -- Periodicals; Gastrointestinal system -- Effect of drugs on -- Periodicals; 615.73
• DOI: 10.1111/apt.12318
• Languages: English
• ISSNs: 0269-2813

Abstract

<abstract abstract-type="main" xml:lang="en" id="apt12318-abs-0001"> <title>Summary</title> <sec id="apt12318-sec-0001" sec-type="section"> <title>Background</title> <p>Alginates form a raft above the gastric contents, which may suppress gastro‐oesophageal reflux; however, inconsistent effects have been reported in mechanistic and clinical studies.</p> </sec> <sec id="apt12318-sec-0002" sec-type="section"> <title>Aims</title> <p>To visualise reflux suppression by an alginate–antacid [Gaviscon Advance (GA), Reckitt Benckiser, UK] compared with a nonraft‐forming antacid using magnetic resonance imaging (MRI), and to determine the feasibility of pH‐impedance monitoring for assessment of reflux suppression by alginates.</p> </sec> <sec id="apt12318-sec-0003" sec-type="section"> <title>Methods</title> <p>Two studies were performed: (i) GA and antacid (Alucol, Wander Ltd, Switzerland) were visualised in the stomach after ingestion in 12 healthy volunteers over 30 min after a meal by MRI, with reflux events documented by manometry. (ii) A randomised controlled, double‐blind cross‐over trial of post‐prandial reflux suppression documented by pH‐impedance in 20 patients randomised to GA or antacid (Milk of Magnesia; Boots, UK) after two meals taken 24 h apart.</p> </sec> <sec id="apt12318-sec-0004" sec-type="section"> <title>Results</title> <p>MRI visualized a "mass" of GA form at the oesophago‐gastric junction (OGJ); simple antacid sank to the distal stomach. The number of post‐prandial common cavity reflux events was less with GA than antacid [median 2 (0–5) vs. 5 (1–11); <italic>P</italic> < 0.035].</p> <p>Distal reflux events and acid exposure measured by pH‐impedance were similar after GA and antacid. There was a trend to reduced proximal reflux events with GA compared with antacid [10.5 (8.9) vs. 13.9 (8.3); <italic>P</italic> = 0.070].</p> </sec> <sec id="apt12318-sec-0005" sec-type="section"> <title>Conclusions</title> <p>Gaviscon Advance forms a 'mass' close to the OGJ and significantly suppresses reflux compared with a nonraft‐forming antacid. Standard pH‐impedance monitoring is suitable for clinical studies of GA in gastro‐oesophageal reflux disease patients where proximal reflux is the primary outcome.</p> </sec> </abstract>