Management

Alginate Reflux Suppressants

Reflux suppressants are used to treat mild-to-moderate GORD.

Mode of action

The basic mode of action of reflux suppressants is physical. Reflux suppressants contain alginic acid or sodium alginate, which combines with gastric HCl to produce a low density viscous ‘raft’ that floats on top of the stomach contents, providing a physical barrier to their reflux back into the oesophagus (Figure 2). Thus the acid, pepsin, bile and food all remain in the stomach.

Efficacy

Reflux suppressants are indicated for the relief of heartburn, reflux oesophagitis, hiatus hernia and dyspepsia due to reflux. For infants there is a specially formulated preparation (Gaviscon Infant [sodium alginate Ph Eur 225 mg and magnesium alginate Ph Eur 87.5 mg per unit dose]) indicated for gastric reflux and regurgitation (possetting).

Dosing

Reflux suppressants are available as liquid and tablets, and are normally administered after meals and at night.

Adverse effects

Reflux suppressants work primarily by forming a physical barrier to the reflux of the stomach contents and are not absorbed by the gut; therefore, overdose is virtually impossible. There are no known significant side effects associated with their use, although patients may experience transient abdominal distension and bloating due to carbon dioxide production inherent in their mode of action. Very rare hypersensitivity reactions have been reported.

Precautions

There are no known contraindications for reflux suppressants, although in patients where sodium intake may cause additional complications, reflux suppressants preparations containing sodium should be used with caution, for example, in patients with certain renal or cardiovascular conditions that demand a restricted salt diet. Similarly, care should be taken in infants with gastroenteritis or renal impairment because the sodium content may increase the physiological levels inappropriately. However, reduced sodium per dose (Gaviscon Advance [sodium alginate 1000 mg Ph Eur, potassium bicarbonate Ph Eur 200 mg per 10 mL dose, 5-10 mL qds]) and infant formulations (Gaviscon Infant) are available.

There is no need to reduce dosage in the elderly, and reflux suppressants can be recommended for use both during pregnancy and lactation.

Management of heartburn in pregnancy

Laryngopharyngeal reflux

More to reflux than Acid

Heartburn in Pregnancy