Department of Gastroenterology and Hepatology, Academic Medical Centre, Amsterdam, the Netherlands.
Clin Gastroenterol Hepatol. 2013 Dec;11(12):1585-91; quiz e90. doi: 10.1016/j.cgh.2013.04.046. Epub 2013 May 10.
BACKGROUND & AIMS: Alginate rafts (polysaccharide polymers that precipitate into a low-density viscous gel when they contact gastric acid) have been reported to form at the acid pocket, an unbuffered pool of acid that floats on top of ingested food and causes postprandial acid reflux. We studied the location of an alginate formulation in relation to the acid pocket and the corresponding effects on reflux parameters and acid pocket positioning in patients with gastroesophageal reflux disease (GERD).
We randomly assigned patients with symptomatic GERD and large hiatal hernias to groups who were given either (111)In-labeled alginate-antacid (n = 8, Gaviscon Double Action Liquid) or antacid (n = 8, Antagel) after a standard meal. The relative positions of labeled alginate and acid pocket were analyzed for 2 hours by using scintigraphy; reflux episodes were detected by using high-resolution manometry and pH-impedance monitoring.
The alginate-antacid label localized to the acid pocket. The number of acid reflux episodes was significantly reduced in patients receiving alginate-antacid (3.5; range, 0-6.5; P = .03) compared with those receiving antacid (15; range, 5-20), whereas time to acid reflux was significantly increased in patients receiving alginate-antacid (63 minutes; range, 23-92) vs those receiving antacid (14 minutes; range, 9-23; P = .01). The acid pocket was located below the diaphragm in 71% of patients given alginate-antacid vs 21% of those given antacid (P = .08). There was an inverse correlation between a subdiaphragm position of the acid pocket and acid reflux (r = -0.76, P < .001).
In a study of 16 patients with GERD, we observed that the alginate-antacid raft localizes to the postprandial acid pocket and displaces it below the diaphragm to reduce postprandial acid reflux. These findings indicate the importance of the acid pocket in GERD pathogenesis and establish alginate-antacid as an appropriate therapy for postprandial acid reflux.
藻酸盐筏（接触胃酸时会沉淀成低密度粘性凝胶的多糖聚合物）据报道会在酸性口袋中形成，酸性口袋是一种未缓冲的胃酸池，漂浮在摄入的食物之上，导致餐后酸反流。我们研究了藻酸盐制剂在酸性口袋中的位置及其对胃食管反流病（GERD）患者反流参数和酸性口袋定位的相应影响。
我们将有症状的 GERD 和大裂孔疝的患者随机分为两组，分别给予（111）In 标记的藻酸盐-抗酸剂（n = 8，Gaviscon Double Action Liquid）或抗酸剂（n = 8，Antagel），在标准餐后进行。通过闪烁扫描术分析标记藻酸盐和酸性口袋的相对位置 2 小时；通过高分辨率测压和 pH 阻抗监测检测反流事件。
藻酸盐-抗酸剂标签定位于酸性口袋。与接受抗酸剂的患者（15；范围，5-20）相比，接受藻酸盐-抗酸剂的患者的酸反流次数明显减少（3.5；范围，0-6.5；P =.03），而接受藻酸盐-抗酸剂的患者的酸反流时间明显延长（63 分钟；范围，23-92）与接受抗酸剂的患者（14 分钟；范围，9-23；P =.01）。在接受藻酸盐-抗酸剂的患者中，71%的酸性口袋位于膈肌下方，而接受抗酸剂的患者中仅为 21%（P =.08）。酸性口袋位于膈肌下方的位置与酸反流呈负相关（r = -0.76，P <.001）。
在 16 例 GERD 患者的研究中，我们观察到藻酸盐-抗酸剂筏定位于餐后酸性口袋，并将其推至膈肌下方，以减少餐后酸反流。这些发现表明酸性口袋在 GERD 发病机制中的重要性，并确立藻酸盐-抗酸剂是治疗餐后酸反流的合适疗法。
