ALGINATES
Place in Therapy
OTC medications can be effective for GERD and heartburn symptoms1,2,3. Alginates have a definite place in patient directed therapy for the treatment of mild forms of GERD1,2,3. Alginates are very effective in the prevention and treatment of GERD following meals, and therefore have a place in therapy treating individuals with infrequent postcibal episodes2,3. Alginate products have a quicker onset than H2RAs5 and a similar onset to antacids3. However, alginates form a raft on top of stomach contents and sustain a layer of high pH on top of the acid solution which lasts up to four hours3. This provides a longer duration of antacid effect than that of conventional antacids. Efficacy at night may theoretically be diminished, as the anti-reflux effects of the raft may be compromised if the patient is in the supine position3.
Currently, the only alginate products available at most pharmacies contain antacids such as magnesium carbonate, aluminum hydroxide, and calcium carbonate. These alginate-antacid combinations may be more effective than both alginate and antacid only products2,6.Both liquid and tablet formulations of alginate products form a raft that floats on gastric contents3 and are equally efficacious4. Alginates have a good safety profile, as their mechanism of action is not dependent on systemic absorption3. However, as alginates are combined with antacids,
the products on the market are associated with the same safety precautions as antacids, such as caution in renal failure.
References
1. DeVault KR, Castell DO; American College of Gastroenterology. Updated guidelines for the diagnosis
and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005
Jan;100(1):190-200.
2. Tran T, Lowry AM, El-Serag HB. Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies. Aliment Pharmacol Ther. 2007 Jan 15;25(2):143-53.
3. Mandel KG, Daggy BP, Brodie DA, Jacoby HI. Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Aliment Pharmacol Ther. 2000 Jun;14(6):669-90. Review.
4. Dettmar PW, Hampson FC, Taubel J, Lorch U, Johnstone LM, Sykes J, Berry PJ. The suppression of gastro-oesophageal reflux by alginates. Int J Clin Pract. 2007 Oct;61(10):1654-62.
5. Dettmar PW, Sykes J, Little SL, Bryan J. Rapid onset of effect of sodium alginate on gastro-oesophageal reflux compared with ranitidine and omeprazole, and relationship between symptoms and reflux episodes. Int J Clin Pract. 2006 Mar;60(3):275-83.
6. Lai IR, Wu MS, Lin JT. Prospective, randomized, and active controlled study of the efficacy of alginic acid and antacid in the treatment of patients with endoscopy-negative reflux disease. World J Gastroenterol. 2006 Feb 7;12(5):747-54.
Currently, the only alginate products available at most pharmacies contain antacids such as magnesium carbonate, aluminum hydroxide, and calcium carbonate. These alginate-antacid combinations may be more effective than both alginate and antacid only products2,6.Both liquid and tablet formulations of alginate products form a raft that floats on gastric contents3 and are equally efficacious4. Alginates have a good safety profile, as their mechanism of action is not dependent on systemic absorption3. However, as alginates are combined with antacids,
the products on the market are associated with the same safety precautions as antacids, such as caution in renal failure.
References
1. DeVault KR, Castell DO; American College of Gastroenterology. Updated guidelines for the diagnosis
and treatment of gastroesophageal reflux disease. Am J Gastroenterol. 2005
Jan;100(1):190-200.
2. Tran T, Lowry AM, El-Serag HB. Meta-analysis: the efficacy of over-the-counter gastro-oesophageal reflux disease therapies. Aliment Pharmacol Ther. 2007 Jan 15;25(2):143-53.
3. Mandel KG, Daggy BP, Brodie DA, Jacoby HI. Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Aliment Pharmacol Ther. 2000 Jun;14(6):669-90. Review.
4. Dettmar PW, Hampson FC, Taubel J, Lorch U, Johnstone LM, Sykes J, Berry PJ. The suppression of gastro-oesophageal reflux by alginates. Int J Clin Pract. 2007 Oct;61(10):1654-62.
5. Dettmar PW, Sykes J, Little SL, Bryan J. Rapid onset of effect of sodium alginate on gastro-oesophageal reflux compared with ranitidine and omeprazole, and relationship between symptoms and reflux episodes. Int J Clin Pract. 2006 Mar;60(3):275-83.
6. Lai IR, Wu MS, Lin JT. Prospective, randomized, and active controlled study of the efficacy of alginic acid and antacid in the treatment of patients with endoscopy-negative reflux disease. World J Gastroenterol. 2006 Feb 7;12(5):747-54.