Antacids and Alginic Acid

·        Antacids remain the drugs of choice for quick relief of symptoms associated with GERD. These agents act primarily by rapidly increasing the pH of the gastric reflux. Antacids are effective in relieving symptoms.

·        Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. Alginic acid reacts with sodium bicarbonate in saliva to form sodium alginate. The sodium alginate floats on top of the gastric contents where it acts as a mechanical barrier, minimizing exposure of the esophagus to reflux.

·        Alginates decrease the number of reflux events by forming a raft on top of the stomach content and thus offer a supplemental mechanism of action to acid suppression. The alginate raft moves into the esophagus in place or ahead of acidic gastric contents during reflux episodes physically preventing reflux of gastric contents into the esophagus. 

·        The raft may remain in the stomach for several hours but is then evacuated, so that 3 or 4 doses per day are required for optimal efficacy.

It's usual to take this up to 4 times a day. It's best to take it after meals and at bedtime. This is usually when the pain and discomfort is worst. 

They can start to ease the symptoms in as little as 5 minutes. The relief may last as little as half an hour or as long as 4 hours.

Antacids don’t do anything to prevent GERD, but they can be used on demand for symptom relief. 

In a general practice setting for patients complaining of mild-moderate heartburn, Alginates plus Antacids is an effective short-term treatment option in mild-to-moderate GERD, in terms of onset of a first 24-h heartburn-free period after initial dosing.

It proved non-inferior to omeprazole 20 mg/day, and is thus a relevant and effective alternative treatment in case of mild-moderate and episodic symptoms of GERD as managed in general practice.

https://www.nice.org.uk/guidance/GID-NG10096/documents/evidence-review-10

https://www.iersurgery.com/general/the-different-stages-of-gerd/

https://www.goodrx.com/blog/best-treatment-acid-reflux-antacids-h2-blockers-proton-pump-inhibitors/

https://www.medscape.com/viewarticle/763058

https://bmcgastroenterol.biomedcentral.com/articles/10.1186/1471-230X-12-18

https://pubmed.ncbi.nlm.nih.gov/28375448/

https://pubmed.ncbi.nlm.nih.gov/26909885/

https://pubmed.ncbi.nlm.nih.gov/22361121/

https://houstonheartburn.com/four-stages-of-gerd/

https://www.aafp.org/afp/1999/0301/p1161.html

https://www.sciencedaily.com/releases/2007/12/071208145406.htm

https://www.medicines.org.uk/emc/product/5609/smpc#gref

https://www.medicines.org.uk/emc/product/113/smpc#gref

Note: For informational purposes only. Consult your textbook for advising your patients.