Randomised clinical trial: the effectiveness of Gaviscon Advance vs non-alginate antacid in suppression of acid pocket and post-prandial reflux in obese individuals after late-night supper

Mohd Adli Deraman, Muhammad Ilham Abdul Hafidz, Rona Marie Lawenko, Zheng Feei Ma, Mung Seong Wong, Cathal Coyle, Yeong Yeh Lee, Mohd Adli Deraman, Muhammad Ilham Abdul Hafidz, Rona Marie Lawenko, Zheng Feei Ma, Mung Seong Wong, Cathal Coyle, Yeong Yeh Lee

Abstract

Background: Late-night supper increases the risk of postprandial reflux from the acid pocket especially in obesity. An alginate-based, raft-forming medication may be useful for obese patients with GERD.

Aims: To compare the efficacy of Gaviscon Advance (Reckitt Benckiser, UK) and a non-alginate antacid in post-supper suppression of the acid pocket and post-prandial reflux among obese participants.

Methods: Participants underwent 48 h wireless and probe-based pH-metry recording of the acid pocket and lower oesophagus, respectively, and were randomised to single post-supper (10 pm) dose of either Gaviscon Advance or a non-alginate antacid on the second night. Primary outcomes were suppression of median pH of acid pocket and lower oesophagus, measured every 10-minutes post-supper for 1 h. Secondary outcomes were suppression of % time pH < 4 at lower oesophagus and improvement in frequency and visual analogue score (VAS) of regurgitation.

Results: Of the 81 screened participants, 55 were excluded and 26 (mean age 33.5 years, males 77.8% and BMI 32.8 kg/m2 ) were randomised to Gaviscon Advance (n = 13) or antacid (n = 13). Median pH of the acid pocket but not the lower oesophagus was suppressed with Gaviscon Advance vs antacid (all P < 0.04) Gaviscon Advance but not antacid significantly reduced in % time pH < 4, symptom frequency and VAS on day 2 vs day 1 (all P < 0.05).

Conclusions: Among obese individuals, Gaviscon Advance was superior to a non-alginate antacid in post-supper suppression of the acid pocket. (Clinical trial registration unique identifier: NCT03516188).

©2020 The Authors. Alimentary Pharmacology & Therapeutics published by John Wiley & Sons Ltd.

Figures

FIGURE 1
FIGURE 1
Study flow chart
FIGURE 2
FIGURE 2
Post‐supper median pH values of the acid pocket on day 1 and day 2 were illustrated for (A) Gaviscon Advance group and (B) non‐alginate antacid group. For median pH values of the lower oesophagus, these were illustrated as (C) for the Gaviscon Advance group and (D) for the non‐alginate antacid group. Asterisks above data points indicate significant differences in median pH between day 1 and day 2 for each group (P < 0.05)
FIGURE 3
FIGURE 3
Illustration to explain the observed effects in the post‐supper median pH of acid pocket and lower oesophagus for Gaviscon Advance and non‐alginate antacid. In non‐obese individuals, Gaviscon Advance lies at the area of acid pocket but antacid below the acid pocket (A), however, in obese individuals, due to increased intra‐abdominal pressure after meal, both Gaviscon Advance and non‐alginate antacid would be pushed up to neutralise acid reflux at lower oesophagus (B)

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