Efficacy of Alginate-Antacid Medication in the Treatment of Patients with Gastroesophageal Reflux Disease
Authors: Storonova O. A. , Trukhmanov A. S. , Ivashkin V. T. 
Published: November 2018

Aim.In this work, we aim to analyze the efficacy of treatment for heartburn and pathological gastroesophageal refluxes (GERs) using alginate-antacid medication. We assess the dynamics of inflammatory process in patients with gastroesophageal reflux disease (GERD) treated with alginate-antacid medication used at conventional dosage, both as a monotherapy and as part of a GERD combination therapy. To this end, we set out to confirm the formation of the layer of unbuffered acidic gastric juice over the gastric chyme after eating, as well as to determine the acidneutralizing effect of alginate-antacid medication upon its interaction with the acidic contents of the stomach.

Materials and methods.36 case records of GERD patients were analyzed (20 women and 16 men, mean age 47.03 years old). All patients were asked to report the heartburn intensity (according to a Likert scale) prior and during the treatment. They were subjected to esophagogastroduodenoscopy (EGD) and 24-hour pH impedance monitoring prior and on the 14th day of treatment. Before treatment, high-resolution esophageal manometry was performed to exclude the esophageal hiatal hernia (EHH) and to determine the upper and lower boundaries of the lower esophageal sphincter (LES). Group 1 included patients with non-erosive reflux disease (NERD), who were receiving monotherapy with alginate-antacid. Patients with the I-II degree of erosive esophagitis (EE) comprised groups 2 and 3, respectively, and were receiving proton pump inhibitor (PPI) monotherapy and PPI and alginate-antacid medication combination therapy, respectively. In group 1, 10 patients were examined using a probe pull-through technique with the purpose of determining pH levels in the cardiac stomach, in the area of the gastro-esophageal junction and in the esophagus at a level of 5 cm above the LES, both in the fasting state and after eating, as well as prior and after using alginate-antacid preparations. 

Results.On the third day of treatment, a complete heartburn relief was observed in 5 (41.6 %) patients of the NERD patient group (group 1), who were receiving a monotherapy with alginate-antacid medication. Heartburn relief was achieved in 3 EE (25 %) and 6 EE patients (50 %) following a PPI treatment course and a PPI and alginate-antacid medication treatment course, respectively. On the 5th day of treatment, heartburn was neutralized in 8 (66.7 %), 7 (58.3 %) and 9 (75 %) patients, with these numbers having risen to 10 (83.3 %), 9 (75 %) and 10 (83.3 %) patients (in the respective groups) on the 14th day. Before treatment, no significant differences in the heartburn intensity were identified between the groups. On the 3rd day of treatment, a significant difference was observed in the dynamics of heartburn intensity between groups 1 – 2 and 2 – 3 (p < 0.05), with this difference having disappeared by the 5th day. According to EGD in the NERD group, inflammation were eliminated in 10 (83.3 %) patients. In EE patients of the 2nd and 3rd groups, the healing of erosions was confirmed in 8 (66.7 %) and 10 (83.3 %) patients, respectively. In general, during the 24-hour pH impedance monitoring, pathological acid, weakly acid and non acid GERs were diagnosed in 28 (77.8 %), 15 (41.7 %) and 9 (25 %) patients, respectively. Under a course of alginate-antacid medication monotherapy, acid reflux was eliminated in 100 % of NERD patients. Among ERD patients undergoing PPI monotherapy, acidic GERs were eliminated in 9 (75 %) patients; however, the addition of alginate-antacid medication to a PPI treatment regimen allowed this result to be increased to 91.7 %. Weakly acid GERs were eliminated in 70 % and 33.3 % of patients in groups 1 and 2, respectively. In group 3, where patients were receiving a PPI and alginate-antacid medication combination treatment, weakly acid GERs were eliminated in 75 % of cases. Non acid refluxes were eliminated in groups 1 and 3 in 50 %, and in 2 – in 33.3 % of cases. When pulling the probe in the fasting state, a sharp change in pH values from acid (0.9–2 units) to weakly acid, and then non acid (5.5–7.6 units), was observed in 100 % of cases. After a meal and before the administration of alginate-antacid medication, the layer of unbuffered acidic gastric juice (pH < 2) was detected in the proximal stomach of 9 patients (90 %). After administration of alginate-antacid medication, the pH ranged from 6.1 to 7.7 units in 7 (70 %) patients, and increased to 4.2 units in 3 people (30 %).

Conclusions.The inclusion of alginate-antacid medication into treatment schemes for managing ERD patients significantly increases its effectiveness, reliably increasing the rate of the onset of the clinical effect. alginate-antacid medication is shown to be an effective monotherapy for NERD. An important advantage of alginate-antacid medication in the treatment of GERD postprandial symptoms consists in its ability to neutralize and displace distally the layer of unbuffered acidic gastric juice, which forms above the chyme surface.