Alginates' chemical and physical properties are derived from various types of seaweeds, which are structural polysaccharides. When it comes to making effective reflux-suppressant products, only specific alginates are suitable. These products have a physical rather than a pharmacological method of action. Alginate from Laminaria hyperborea, bicarbonate from sodium, and carbonate from calcium make up the most effective products' active components. After being injected into the acidic gastric environment, this mixture forms a robust alginate raft that is both dense and buoyant. Studies have shown that up to 40% to 60% of Western populations can benefit from alginate-based products. This advantage is rapidly expanding in other countries where reflux disease is now recognised as a serious and growing concern.

Gastroesophageal Reflux Disease (GERD)

GERD is a "condition that generates when the reflux of gastric content causes bothersome symptoms or complications." GERD and heartburn symptoms can be alleviated by the raft's ability to reduce reflux. Previous studies show that GERD affects a large percentage of the world's population and lowers their overall health-related quality of life. A recent meta-analysis shows that the prevalence of GERD has increased significantly over the past two decades. 

Pharmaceutical Formulations based on Alginate

For decades, pharmaceutical formulations based on alginate have been used to treat the symptoms of GERD, and the relief of symptoms has been quick. However, as GERD understanding and awareness have developed over the past twenty years, the symptoms of extraesophageal reflux (EER), also known as airway reflux, silent reflux, and laryngopharyngeal acid reflux disorder (LAAR), have become more prevalent (LPR). In light of this new knowledge, we now know that reflux of stomach contents into the lungs, nose, and ears can cause a slew of ENT and respiratory symptoms, including the need for alginate-based medicinal medications.

It is critical to choose the right alginate for various reasons, including the following: Alginates function in a nonsystemic, physical manner rather than a pharmaceutical one. In addition, there are different modes of action of alginates; some are described as:

• For people with GERD, alginate forms a physical barrier that helps to eliminate or displace the acid pocket. After a meal, an acid pocket forms at the gastroesophageal junction, which contains an unbuffered, highly acidic gastric liquid and is associated with GERD pathophysiology. Therefore, postprandial acid reflux can be prevented or at least reduced with the use of a strong alginate raft.
• Pepsin and bile acids can be removed from gastric refluxate by alginate, which reduces their diffusion and especially affects the enzymatic activity of pepsin.
• Alginates are important in protecting the oesophagal mucosa from the acid, pepsin, and bile acid components of the gastric refluxate, which can cause inflammation. The mucosa of the oesophagus lining is very vulnerable to the effects of gastric reflux. The right Na alginate can form adhering viscous layers on contact with the mucosa and display bioadhesive potential in this location.
• In addition, for an alginate gel to be strong, it must have a G-block structure, which leads to the formation of a low-density viscous gel floating on top of the stomach. This creates a physical barrier to keep stomach acid out of the fragile oesophagal mucosa and the respiratory system.

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References

Vakil, N., Van Zanten, S. V., Kahrilas, P., Dent, J., Jones, R., Bianchi, L. K., & Cesario, K. B. (2006). The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. The American Journal of Gastroenterology, 101(8). https://doi.org/10.1111/J.1572-0241.2006.00630.X

Gupta, S., & Abu-Ghannam, N. (2011). Bioactive potential and possible health effects of edible brown seaweeds. Trends in Food Science & Technology, 22(6), 315–326. https://doi.org/10.1016/J.TIFS.2011.03.011

Bor, S., Kalkan, İ. H., Çelebi, A., Dinçer, D., Akyüz, F., Dettmar, P., & Özen, H. (2019). Alginates: From the ocean to gastroesophageal reflux disease treatment. The Turkish Journal of Gastroenterology, 30(Suppl 2), S109. https://doi.org/10.5152/TJG.2019.19677

Kwiatek, M. A., Roman, S., Fareeduddin, A., Pandolfino, J. E., & Kahrilas, P. J. (2011). An alginate-antacid formulation (Gaviscon Double Action Liquid) can eliminate or displace the postprandial “acid pocket” in symptomatic GERD patients. Alimentary Pharmacology & Therapeutics, 34(1), 59–66. https://doi.org/10.1111/J.1365-2036.2011.04678.X

Kwiatek, M. A., Roman, S., Fareeduddin, A., Pandolfino, J. E., & Kahrilas, P. J. (2011). An alginate-antacid formulation (Gaviscon Double Action Liquid) can eliminate or displace the postprandial “acid pocket” in symptomatic GERD patients. Alimentary Pharmacology & Therapeutics, 34(1), 59–66. https://doi.org/10.1111/J.1365-2036.2011.04678.X

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