Alginates in the treatment of gastroesophageal reflux disease: real clinical practice

August 24, 2023
УДК:  616.33-002.44:611.018
Specialities :

The article discusses the modern paradigm of gastroesophageal reflux disease (GERD). In recent years, views have shifted toward a personalized approach to the assessment and treatment of disease symptoms. Although proton pump inhibitors dominate over other drugs, the contribution of alginates is increasing among GERD treatment regimens due to their unique properties. Alginates are used both as monotherapy and in combination with proton pump inhibitors. 4 clinical cases of GERD, which are typical for the outpatient setting, are presented and discussed. The use of alginates significantly improves and simplifies GERD therapy. The drugs of the pharmacological line of Gaviscon® (Reckkitt Benckiser Helsker (UK) Limited, Great Britain) are optimal both for course treatment and for «on-demand» therapy, fully meeting the requirements of treatment standards. At the same time, the compliance is easily achieved due to the ease of use, the pronounced effect in the treatment and the affordable price.


1. Pandit S., Boktor M., Alexander J.S. et al. (2018) Gastroesophageal Reflux Disease: A Clinical Overview for Primary Care Physicians. Pathophysiology, 25(1): 1–11. doi: 10.1016/j.pathophys.2017.09.001.

2. El-Serag H.B., Sweet S., Winchester C.C., Dent J. (2014) Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut, 63: 871–80. doi: 10.1136/gutjnl-2012-304269.

3. GBD 2017 Gastro-oesophageal Reflux Disease Collaborators (2020) The global, regional, and national burden of gastro-oesophageal reflux disease in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol., 5(6): 561–581. doi: 10.1016/S2468-1253(19)30408-X.

4. Ofman J.J. (2003) The Economic and Quality-of- Life Impact of Symptomatic Gastroesophageal Reflux Disease. Am. J. Gastroenterol., 98(3 Suppl.): S8–S14. doi: 10.1016/s0002-9270(03)00010-8.

5. Eslick G.D., Talley N.J. (2009) Gastroesophageal reflux disease (GERD): risk factors, and impact on quality of life-a population-based study. J. Clin. Gastroenterol., 43(2): 111–117. doi: 10.1097/MCG.0b013e31815ea27b.

6. Fashner J. (2020) Gastroesophageal Reflux Disease: A General Overview. HCA Healthc J. Med., 1(4): 191–199. doi: 10.36518/2689-0216.1042.

7. Rochoy M., Dubois S., Glantenet R. et al. (2018) Le rebond d’acidité gastrique après arrêt d’un inhibiteur de la pompe à protons : revue narrative de littérature [Gastric acid rebound after a proton pump inhibitor: Narrative review of literature]. Therapie, 73(3): 237–246. doi: 10.1016/j.therap.2017.08.005.

8. Agwaonye S., Vasant D.H. (2023) Optimising reflux symptom burden and patient compliance during PPI washout periods for oesophageal pH monitoring studies: should we be more proactive with alginate use? BMJ Open Gastroenterol., 10(1): e001078. doi: 10.1136/bmjgast-2022-001078.

9. Dunbar K., Yadlapati R., Konda V. (2022) Heartburn, Nausea, and Vomiting During Pregnancy. Am. J. Gastroenterol., 117(10S): 10–15. doi: 10.14309/ajg.0000000000001958.

10. Dekkers G.W.F., Broeren M.A.C., Truijens S.E.M. et al. (2020) Hormonal and psychological factors in nausea and vomiting during pregnancy. Psychol. Med., 50(2): 229–236. doi: 10.1017/S0033291718004105.

11. Strugala V., Bassin J., Swales V.S. et al. (2012) Assessment of the Safety and Efficacy of a Raft Forming Alginate Reflux Suppressant (Liquid Gaviscon) for the Treatment of Heartburn during Pregnancy. ISRN Obstet. Gynecol., 2012: 481870. doi: 10.5402/2012/481870.

12. Щербинина М.Б., Луговская Т.В., Иванченко Н.А., Коваленко Г.А. (2016) Оценка эффективности препарата Гавискон Форте в терапии изжоги беременных. Здоровье женщины, 7: 84–90.

13. Katz P.O., Dunbar K.B., Schnoll-Sussman F.H. et al. (2022) ACG Clinical Guideline for the Diagnosis and Management of Gastroesophageal Reflux Disease. Am. J. Gastroenterol., 117(1): 27–56. doi: 10.14309/ajg.0000000000001538.

14. Razgallah N., Galasso D., Le Bloc’h F., Firmann M. (2023) Utilisation des inhibiteurs de la pompe à protons en pratique [Practice review on the use of proton pump inhibitors]. Rev. Med. Suisse, 19(814): 340–345. doi: 10.53738/REVMED.2023.19.814.340.

15. Poddar U. (2019) Gastroesophageal reflux disease (GERD) in children. Paediatr. Int. Child Health, 39(1): 7–12. doi: 10.1080/20469047.2018.1489649.

16. Choi Y.J., Ha E.K., Jeong S.J. (2016) Dietary habits and gastroesophageal reflux disease in preschool children. Korean J. Pediatr., 59(7): 303–307. doi: 10.3345/kjp.2016.59.7.303.

17. Winter H.S., Illueca M., Henderson C., Vaezi M. (2011) Review of the persistence of gastroesophageal reflux disease in children, adolescents and adults: does gastroesophageal reflux disease in adults sometimes begin in childhood? Scand J. Gastroenterol., 46(10): 1157–1168. doi: 10.3109/00365521.2011.591425.

18. Krause A.J., Walsh E.H., Weissbrod P.A. et al. (2022) An update on current treatment strategies for laryngopharyngeal reflux symptoms. Ann. N.Y. Acad. Sci., 1510(1): 5–17. doi: 10.1111/nyas.14728.

19. Koufman J.A. (1991) The otolaryngologic manifestations of gastroesophageal reflux disease (GERD): a clinical investigation of 225 patients using ambulatory 24-hour pH monitoring and an experimental investigation of the role of acid and pepsin in the development of laryngeal injury. Laryngoscope, 101(4 Pt. 2 Suppl. 53): 1–78. doi: 10.1002/lary.1991.101.s53.1.

20. Wright R.A., Miller S.A., Corsello B.F. (1990) Acid-induced esophagobronchial-cardiac reflexes in humans. Gastroenterology, 99(1): 71–73. doi: 10.1016/0016-5085(90)91231-t.

21. McGlashan J.A., Johnstone L.M., Sykes J. et al. (2009) The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux. Eur. Arch. Otorhinolaryngol., 266(2): 243–251. doi: 10.1007/s00405-008-0708-7.

22. Lechien J.R., Bock J.M., Carroll T.L., Akst L.M. (2020) Is empirical treatment a reasonable strategy for laryngopharyngeal reflux? A contemporary review. Clin. Otolaryngol., 45(4): 450–458.

23. Reimer C., Lødrup A.B., Smith G. et al. (2016) Randomised clinical trial: alginate (Gaviscon Advance) vs. placebo as add-on therapy in reflux patients with inadequate response to a once daily proton pump inhibitor. Aliment. Pharmacol. Ther., 43(8): 899–909. doi: 10.1111/apt.13567.

24. Wilkinson J., Wade A., Thomas S.J. et al. (2019) Randomized clinical trial: a double-blind, placebo-controlled study to assess the clinical efficacy and safety of alginate-antacid (Gaviscon Double Action) chewable tablets in patients with gastro-oesophageal reflux disease. Eur. J. Gastroenterol. Hepatol., 31(1): 86–93. doi: 10.1097/MEG.0000000000001258.

25. Chen J.W., Vela M.F., Peterson K.A., Carlson D.A. (2023) AGA Clinical Practice Update on the Diagnosis and Management of Extraesophageal Gastroesophageal Reflux Disease: Expert Review. Clin. Gastroenterol. Hepatol., 21(6): 1414–1421.e3. doi: 10.1016/j.cgh.2023.01.040.

26. Vales A., Coyle C., Plehhova K. et al. (2023) Randomised clinical trial: the use of alginates during preinvestigation proton pump inhibitor wash-out and their impact on compliance and symptom burden. BMJ Open Gastroenterol., 10(1): e001026. doi: 10.1136/bmjgast-2022-001026.

27. Hungin A.P.S., Molloy-Bland M., Scarpignato C. (2019) Revisiting Montreal: New Insights into Symptoms and Their Causes, and Implications for the Future of GERD. Am. J. Gastroenterol., 114(3): 414–421. doi: 10.1038/s41395-018-0287-1.