Alginate, a type of fibre found in seaweed, has been used to help with the symptoms of reflux disease for many years.
Alginates naturally occur as structural polysaccharides in brown algae and have a unique mode of action, producing a ‘raft’.
This gel raft floats on top of the stomach contents and acts as a protective barrier, preventing stomach contents from escaping and thus irritating the oesophagus. Popular anti-reflux products, such as Gaviscon Advance, contain alginates.
Alginates produced from different seaweeds have different chemical compositions and physical properties, and only certain alginates have the right characteristics to be used to manufacture effective reflux-suppressant products.
A new expert opinion paper, co-authored by Professor Peter Dettmar, has evaluated the different aspects of alginate treatment in patients and concluded that alginates are effective and are safe for the treatment of gastro-oesophageal reflux disease (GORD) in children and studies show alginate treatment improved symptoms, such as regurgitation, the incidence and severity of vomiting, crying and fussiness.
It also concludes that alginates are the preferred treatment for mild GORD symptoms and can be used in combination with PPIs (proton pump inhibitors) to improve symptoms and severity of reflux in PPI unresponsive GORD. Furthermore, alginates can be used either long term or for on-demand therapy for people who no longer use PPIs. In particular, the study suggests the following approaches for tapering (gradually decreasing the dose) or stopping PPIs:
In particular, the study suggests following approaches for tapering (gradually decreasing the dose) or stopping PPIs:
- Fully stop PPIs and observe patients with mild symptoms
- Taper the dose and stop
- Switch to intermittent or on-demand use with PPIs and/or alginate
- Decrease to the lowest effective dose and continue
- Stop and continue with alginate, with either continuous or on-demand treatment with alginate or another non-PPI agent
The experts also say that alginates can be safely used in pregnancy and lactation as a first-line therapy.
The paper, Alginates: From the ocean to gastroesophageal reflux disease treatment, has been published in the Turkish Journal of Gastroenterology.
- Each alginate has different characteristics. Studies have shown that Laminaria hyperborea (a species of large brown alga) is able to form strong, coherent, voluminous and highly buoyant rafts compared to others.
- Only alginates with a very low molecular weight and high gel strength are suitable for the manufacture of effective reflux-suppressant products
- Alginate can remove both pepsin and bile acids from gastric refluxate, limiting their diffusion and specifically affecting the enzymatic activity of pepsin