In the Journals

Alginate therapy an effective alternative for treating GERD symptoms

Alginate-based therapies appear slightly less effective than histamine-2 receptor antagonists and proton pump inhibitors, but more effective than placebo and antacids for treating GERD symptoms, according to the results of a systematic review and meta-analysis.

These data led researchers to conclude that alginates are an effective alternative option for the management of GERD symptoms, especially in patients with mild or intermittent symptoms.

David A. Leiman, MD, MSHP

David A. Leiman

“Although many patients respond well to treatment with acid suppressive therapy with proton pump inhibitors (PPIs), unfortunately some will not experience complete symptom control even at high doses of medication. Also, several recent studies have generated substantial concern among some patients and providers about possible long-term side effects of PPI use,” David A. Leiman, MD, MSHP, from the division of gastroenterology at Duke University School of Medicine, told Healio Gastroenterology. “Alginic acid derivatives, or alginates, are an alternative treatment for GERD that work via a physical rather than pharmacologic mechanism to treat reflux. These medications have been available for over 40 years but their use is not formally recommended as part of current treatment guidelines.”

Leiman and colleagues reviewed randomized controlled trials of alginates vs. other GERD treatments published through October 2015, and ultimately included 14 studies involving a total of 2,095 adults in their meta-analysis.

Based on nine studies involving 900 individuals, they determined that alginate-based treatments increased the likelihood of GERD symptom resolution compared with placebo or antacids (OR = 4.42; 95% CI, 2.45-7.97), with moderate heterogeneity between studies (P = .001). Moreover, based on five studies involving 1,195 individuals, alginates appeared less effective compared with PPIs or H2Ras, but this did not reach statistical significance (OR = 0.58; 95% CI, 0.27-1.22), and there was a high degree of heterogeneity between studies (P < .001).

“Our study definitively shows that alginates are effective in the management of symptomatic GERD,” Leiman said. “An unexpected finding was that PPIs were not significantly superior to alginates in the analyzed studies. These data support the use of alginates, particularly for patients with mild or intermittent symptoms (less than once a week). We believe that treatment guidelines should reflect these findings and discuss a role of alginates in this group of patients.”

While this study did not explore comparative safety between treatments, “alginates are natural polysaccharide polymers isolated from seaweed,” and several previous studies, “including those on infants and pregnant women, show they are generally well tolerated without significant side effects,” Leiman added. Further research is needed to identify patient groups for whom alginates are most effective.

“It’s important to note, though, that in patients with erosive esophagitis or other complications of GERD, PPIs should still be considered first-line treatment,” he noted.

Alginate-based compounds are typically sold under the brand name Gaviscon (GlaxoSmithKline) in both non-prescription tablet and liquid formulations in the U.S. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.

Alginate-based therapies appear slightly less effective than histamine-2 receptor antagonists and proton pump inhibitors, but more effective than placebo and antacids for treating GERD symptoms, according to the results of a systematic review and meta-analysis.

These data led researchers to conclude that alginates are an effective alternative option for the management of GERD symptoms, especially in patients with mild or intermittent symptoms.

David A. Leiman, MD, MSHP

David A. Leiman

“Although many patients respond well to treatment with acid suppressive therapy with proton pump inhibitors (PPIs), unfortunately some will not experience complete symptom control even at high doses of medication. Also, several recent studies have generated substantial concern among some patients and providers about possible long-term side effects of PPI use,” David A. Leiman, MD, MSHP, from the division of gastroenterology at Duke University School of Medicine, told Healio Gastroenterology. “Alginic acid derivatives, or alginates, are an alternative treatment for GERD that work via a physical rather than pharmacologic mechanism to treat reflux. These medications have been available for over 40 years but their use is not formally recommended as part of current treatment guidelines.”

Leiman and colleagues reviewed randomized controlled trials of alginates vs. other GERD treatments published through October 2015, and ultimately included 14 studies involving a total of 2,095 adults in their meta-analysis.

Based on nine studies involving 900 individuals, they determined that alginate-based treatments increased the likelihood of GERD symptom resolution compared with placebo or antacids (OR = 4.42; 95% CI, 2.45-7.97), with moderate heterogeneity between studies (P = .001). Moreover, based on five studies involving 1,195 individuals, alginates appeared less effective compared with PPIs or H2Ras, but this did not reach statistical significance (OR = 0.58; 95% CI, 0.27-1.22), and there was a high degree of heterogeneity between studies (P < .001).

“Our study definitively shows that alginates are effective in the management of symptomatic GERD,” Leiman said. “An unexpected finding was that PPIs were not significantly superior to alginates in the analyzed studies. These data support the use of alginates, particularly for patients with mild or intermittent symptoms (less than once a week). We believe that treatment guidelines should reflect these findings and discuss a role of alginates in this group of patients.”

While this study did not explore comparative safety between treatments, “alginates are natural polysaccharide polymers isolated from seaweed,” and several previous studies, “including those on infants and pregnant women, show they are generally well tolerated without significant side effects,” Leiman added. Further research is needed to identify patient groups for whom alginates are most effective.

“It’s important to note, though, that in patients with erosive esophagitis or other complications of GERD, PPIs should still be considered first-line treatment,” he noted.

Alginate-based compounds are typically sold under the brand name Gaviscon (GlaxoSmithKline) in both non-prescription tablet and liquid formulations in the U.S. – by Adam Leitenberger

Disclosures: The researchers report no relevant financial disclosures.