Date of Award

2013

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not sodium alginate solutions are effective in reducing postprandial symptoms in adults with gastroesophageal reflux?

STUDY DESIGN: A review of three English language studies published from 2006-2011. Includes two randomized, double-blind, controlled trials and one controlled case series.

DATA SOURCES: Randomized, placebo-controlled studies evaluating the effectiveness and safety of sodium alginate solutions (Gaviscon) for managing gastroesophageal reflux disease (GERD) symptoms in adults were located using the PubMed, CINAHL, and Cochrane Library databases.

OUTCOMES MEASURED: The primary measures of effectiveness used were the Reflux Severity Index Questionnaire and Reflux Disease Questionnaire. The secondary measures of effectiveness were the incidence of symptoms with time of onset and time until resolution. The measures of symptom reduction included heartburn (epigastric, substernal pain), acid taste in mouth, regurgitation, nausea, flatulence, hoarseness, excess mucous and throat clearing, and cough.

RESULTS: Two randomized, controlled studies and one controlled case series comparing sodium alginate solutions to a placebo, proton pump inhibitor and H2 receptor antagonist were reviewed. Dettmar et al. noted a statistically significant decrease in incidence of esophageal symptoms compared to control and omeprazole. McGlashan and colleagues noted a mean reduction in severity of
symptoms at two and six months after Gaviscon treatment compared with control. Kwiatek et al. noted a statistically significant reduction in an acid taste in patients’ mouths after Gaviscon treatment. All three studies also found sodium alginate solutions to be well tolerated. The majority of adverse events were mild; the most common events included mild nausea and headache.

CONCLUSIONS: The results of all three studies in this review support a similar conclusion, that sodium alginate solutions are both effective and safe in the treatment of adults over 18 years of age diagnosed with GERD. Liquid alginate suspensions like Gaviscon formulations provide an alternative, non-systemic, barrier mode of action in the treatment of GERD. Further research regarding specific formulations available and the role in prevention of Barrett’s esophagus is warranted.

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