The effectiveness of alginate-antacids vs non-alginate antacid in suppression of acid pocket & post-prandial reflux in obese individuals
Key Information
In the last decade, gastro-esophageal reflux disease (GERD) and its complications of Barrett's oesophagus and oesophageal adenocarcinoma are increasingly prevalent, especially in Asia. The rise in GERD among Asians is largely attributed to a recent increase in the prevalence of obesity.
Physiological dysfunction of the gastro-esophageal junction (GOJ) in the form of partial hiatus hernia may explain the excess distal esophageal acid exposure in obesity. Acid pocket, an area distal to GOJ that escape normal buffering of a meal, is a reservoir of acid that readily refluxes but it also expands in the presence of a hernia.
FIGURE
Illustration to explain the observed effects in the post-supper median pH of acid pocket and lower oesophagus for alginate-antacids and non-alginate antacid. In non-obese individuals, alginate-antacids lies at the area of acid pocket but antacid below the acid pocket (A), however, in obese individuals, due to increased intra-abdominal pressure after meal, both alginate-antacids and non-alginate antacid would be pushed up to neutralise acid reflux at lower oesophagus (B)
Unlike the usual antacid or proton-pump inhibitor (PPI), alginate-based reflux suppressants, have the capability to displace the acid pocket but also form a physical barrier against reflux through formation of alginate raft at the GOJ.
GERD symptoms frequently happen at night but may also have a higher impact at night compared to daytime due to loss of usual physiological function associated with sleep and the supine position.
The aim of this study was to investigate the effectiveness and mechanistic advantages of alginate-antacids advantage over non-alginate antacids in suppressing acid pocket and post-prandial reflux in obese participants following a heavy late-night supper.
Study found that among obese individuals, alginate-antacids was superior to a non-alginate antacid in post-supper suppression of the acid pocket.
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Background
Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for obese patients with GERD.
Aims
To compare the efficacy of alginate-antacids and a non-alginate antacid in post-supper suppression of the acid pocket and post-prandial reflux among obese participants.
Methods
Participants underwent 48 h wireless and probe-based pH-metry recording of the acid pocket and lower oesophagus, respectively, and were randomised to single post-supper (10 pm) dose of either alginate-antacids or a non-alginate antacid on the second night. Primary outcomes were suppression of median pH of acid pocket and lower oesophagus, measured every 10-minutes post-supper for 1 h. Secondary outcomes were suppression of % time pH < 4 at lower oesophagus and improvement in frequency and visual analogue score (VAS) of regurgitation.
Results
Of the 81 screened participants, 55 were excluded and 26 (mean age 33.5 years, males 77.8% and BMI 32.8 kg/m2) were randomised to alginate-antacids (n = 13) or antacid (n = 13). Median pH of the acid pocket but not the lower oesophagus was suppressed with alginate-antacids vs antacid. Alginate-antacids but not antacid significantly reduced in % time pH < 4, symptom frequency and VAS on day 2 vs day 1.
Conclusions
Among obese individuals, alginate-antacids was superior to a non-alginate antacid in post-supper suppression of the acid pocket.
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