An Alginate-Antacid Formulation Localizes to the Acid Pocket to Reduce Acid Reflux in Patients With Gastroesophageal Reflux Disease  Wout O. Rohof, Roel J. Bennink, Andre J.P.M. Smout, Edward Thomas, Guy E. Boeckxstaens  Clinical Gastroenterology and Hepatology  Volume 11, Issue 12, Pages 1585-1591 (December 2013) DOI: 10.1016/j.cgh.2013.04.046 Copyright © 2013 AGA Institute Terms and Conditions

Figure 1 Study design. Clinical Gastroenterology and Hepatology 2013 11, 1585-1591DOI: (10.1016/j.cgh.2013.04.046) Copyright © 2013 AGA Institute Terms and Conditions

Figure 2 Scintigraphic images of 99mTc-pertechnetate–labeled acid pocket (A) and 111mIn-labeled alginate-antacid (B) and the 2 scintigraphic recordings superimposed (C). After a meal, 99mTc-pertechnetate is excreted by the parietal cells of the stomach, and this visualizes the acid pocket near the EGJ (A). After intake, 111mIn-labeled alginate-antacid (B) is present in the proximal stomach. Superimposed, it is demonstrated that the 111mIn-labeled alginate-antacid is present on top and co-localizes with the acid pocket in the proximal stomach. In the Supplementary Video, the superimposed dynamic images demonstrate that the alginate-antacid remains in this position during the entire study period. Clinical Gastroenterology and Hepatology 2013 11, 1585-1591DOI: (10.1016/j.cgh.2013.04.046) Copyright © 2013 AGA Institute Terms and Conditions

Figure 3 The mean numbers of reflux events (A), acid reflux episodes (B), and esophageal acid exposure (C) were reduced by alginate-antacid compared with antacid, but the mean number of weakly acid reflux episodes was higher with alginate-antacid (D). Clinical Gastroenterology and Hepatology 2013 11, 1585-1591DOI: (10.1016/j.cgh.2013.04.046) Copyright © 2013 AGA Institute Terms and Conditions

Figure 4 Buffering capacity (A) was similar for antacid and alginate-antacid. However, mean time to acid reflux (B) and mean pH of reflux episodes (C) were significantly increased with alginate-antacid compared with antacid. Clinical Gastroenterology and Hepatology 2013 11, 1585-1591DOI: (10.1016/j.cgh.2013.04.046) Copyright © 2013 AGA Institute Terms and Conditions

Figure 5 There was a trend for the acid pocket to be located below the diaphragm at an increased rate with alginate-antacid compared with antacid treatment (A). Subdiaphragmatic positioning negatively correlated with acid reflux (B). ***r = –0.76, P < .001. Clinical Gastroenterology and Hepatology 2013 11, 1585-1591DOI: (10.1016/j.cgh.2013.04.046) Copyright © 2013 AGA Institute Terms and Conditions