Alginate rafting agents in gastro-oesophageal reflux disorder: a critical review

摘要

Gastro-oesophageal reflux disorder (GORD) is common in the industrialised world, impairs health-related quality of life and either causes or exacerbates several potentially serious conditions. Alginates, which are either purchased over the counter or prescribed, are widely used in GORD management. Nevertheless, there is a need to better characterise the relative merits and limitations of drugs used to treat GORD. Previous studies offer some such evidence for proton pump inhibitors (PPIs) and H_2 receptor antagonists. However, reviews of alginates are sparse.As a result, this review aimed to characterise the efficacy, tolerability and pharmacoeconomics of alginates in GORD management. The review also aimed to determine whether the choice of alginate influenced sodium load. The recent advice by the UK Scientific Advisory Committee on Nutrition(SACN) to reduce average salt intake prompted this consideration.The evidence base supporting alginates is less extensive than that for either H_2 receptor antagonists or PPIs. Nevertheless, alginates appear to be effective and well tolerated in GORD. There is no compelling evidence that alginate formulations differ in either efficacy or tolerability. Sodium load and cost seem to be the only factors that differentiate the formulations.A cost-minimisation analysis from the perspective of the UK suggested that Gastrocote~R is preferable to Gaviscon~R. The differences in formulation result in Gaviscon?being associated with higher sodium load than Gastrocote~R and Gaviscon~R Advance. As the other clinical outcomes are similar, it is reasonable, on balance, to suggest that Gastrocote~R should be the alginate of choice for GORD. Further studies are needed, however, to confirm this hypothesis.