The role of alginate-based therapy in gastroesophageal reflux disease

Abstract

Gastroesophageal reflux disease (GERD) is one of the most common digestive pathologies, with worldwide spread and increasing incidence. Due to the chronic nature of this condition, the dreaded complications that can occur during evolution and the negative impact on patients' quality of life, it is imperative to administer symptomatic treatment to eliminate or improve symptoms, cure erosive esophagitis and prevent recurrences and complications. Alginic acid formulations have a unique, particular mechanism of action, acting as a long-lasting physical barrier floating on the surface of the gastric pool, displacing the postprandial gastric acid pocket and protecting esophagus mucosa during reflux episodes. Numerous studies evaluated the efficacy of alginate treatment in GERD, by comparison to antacids, proton pump inhibitors (PPIs), histamine 2 receptor antagonists (H2RAs), or placebo. While most studies found superiority of alginate treatment when compared to antacids or to placebo, PPIs treatment was overall more effective than alginate in controlling GERD symptoms. There were some trials that reported alginate non-inferiority when compared to PPIs, especially in the setting of NERD. Thus, alginate could represent a therapeutic alternative to PPIs in this category of patients. The current trends according to the current guidelines promote as the first recommendation in GERD management the treatment with PPIs. However, alginate/antacid therapy has a well-established place as additional therapy for PPIs or in mild forms with less than two episodes of heartburn per week as the first administration therapy.

Keywords

• gastroesophageal reflux disease
• gastric acid pocket
• alginate-based therapy