title: Alginate therapy is effective treatment for GERD symptoms: a systematic review and meta-analysis.
abstract: In patients with gastroesophageal reflux disease (GERD) and erosive esophagitis, treatment with proton pump inhibitors (PPIs) is highly effective. However, in some patients, especially those with nonerosive reflux disease or atypical GERD symptoms, acid-suppressive therapy with PPIs is not as successful. Alginates are medications that work through an alternative mechanism by displacing the postprandial gastric acid pocket. This study performed a systematic review and meta-analysis to examine the benefit of alginate-containing compounds in the treatment of patients with symptoms of GERD. PubMed/MEDLINE, Embase, and the Cochrane library electronic databases were searched through October 2015 for randomized controlled trials comparing alginate-containing compounds to placebo, antacids, histamine-2 receptor antagonists (H2RAs), or PPIs for the treatment of GERD symptoms. Additional studies were identified through a bibliography review. Non-English studies and those with pediatric patients were excluded. Meta-analyses were performed using random-effect models to calculate odds ratios (OR). Heterogeneity between studies was estimated using the I2 statistic. Analyses were stratified by type of comparator. The search strategy yielded 665 studies and 15 (2.3%) met inclusion criteria. Fourteen were included in the meta-analysis (N = 2095 subjects). Alginate-based therapies increased the odds of resolution of GERD symptoms when compared to placebo or antacids (OR: 4.42; 95% CI 2.45-7.97) with a moderate degree of heterogeneity between studies (I2 = 71%, P = .001). Compared to PPIs or H2RAs, alginates appear less effective but the pooled estimate was not statistically significant (OR: 0.58; 95% CI 0.27-1.22). Alginates are more effective than placebo or antacids for treating GERD symptoms.
authors.affiliation: Division of Gastroenterology, Duke University School of Medicine, Durham, North Carolina.
authors.forename: D A
authors.initials: DA
authors.lastname: Leiman
authors.affiliation: Division of Gastroenterology, Icahn School of Medicine at Mt. Sinai, New York, New York, USA.
authors.forename: B P
authors.initials: BP
authors.lastname: Riff
authors.affiliation: Center for Evidence-based Practice.
authors.forename: S
authors.initials: S
authors.lastname: Morgan
authors.affiliation: Division of Gastroenterology.
authors.forename: D C
authors.initials: DC
authors.lastname: Metz
authors.affiliation: Division of Gastroenterology.
authors.forename: G W
authors.initials: GW
authors.lastname: Falk
authors.affiliation: Center for Evidence-based Practice.|Department of Biostatistics and Epidemiology.|Leonard Davis Institute of Health Economics.|Center for Clinical Epidemiology and Biostatistics.
authors.forename: B
authors.initials: B
authors.lastname: French
authors.affiliation: Center for Evidence-based Practice.|Department of Biostatistics and Epidemiology.|Leonard Davis Institute of Health Economics.|Center for Clinical Epidemiology and Biostatistics.|Division of General Internal Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: C A
authors.initials: CA
authors.lastname: Umscheid
authors.affiliation: Division of Gastroenterology.|Department of Biostatistics and Epidemiology.|Leonard Davis Institute of Health Economics.|Center for Clinical Epidemiology and Biostatistics.
authors.forename: J D
authors.initials: JD
authors.lastname: Lewis
mesh_terms: D000328:Adult; D000464:Alginates / Q000627:therapeutic use*; D000863:Antacids / Q000627:therapeutic use*; D005260:Female; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D020723:Glucuronic Acid / Q000627:therapeutic use; D006603:Hexuronic Acids / Q000627:therapeutic use; D006635:Histamine H2 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016032:Randomized Controlled Trials as Topic; D016896:Treatment Outcome
chemical_list: D000464:Alginates; D000863:Antacids; D006603:Hexuronic Acids; D006635:Histamine H2 Antagonists; D054328:Proton Pump Inhibitors; D020723:Glucuronic Acid
keywords: alginate; gastroesophageal reflux disease; meta-analysis