В настоящее время гастроэзофагеальная рефлюксная болезнь (ГЭРБ) достаточно широко распространена в мире. При этом отмечается падение качества жизни пациентов, страдающих ГЭРБ. Согласно теории кислотного кармана, в соответствии с которой наибольшая кислотность после прима пищи наблюдается в проксимальных отделах желудка, и симптомы ГЭРБ в основном обусловлены забросом верней части желудочного содержимого в нижнюю треть пищевода, кислотный карман должен являться точкой приложения в лечении данной патологии. Именно на него и воздействуют альгинаты, представляющие собой полимер полисахарида, при приме внутрь после еды нейтрализующие кислотный карман. Данная статья посвящена обзору эффективности и безопасности альгинатов у пациентов с ГЭРБ.
Gastroesophageal reflux disease (GERD) is a widespread disorder all over the world, nowadays. There is a reduction in quality of life of patients suffering from GERD. According to the theory of acid pocket in which the highest acidity occurs after meals in proximal part of the stomach and GERD symptoms are generally associated with reflux of gastric contents into the lower third of the esophagus from the upper part, acid pocket should be a target for the treatment in this disorder. The alginates are polysaccharide polymers, which acting on acid pocket as antacid and should be per os administered after meal. This article is devoted to the review of the efficiency and safety of alginates in patients with GERD.
1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014; 63 (6): 871–80.
2. Shirai T, Mikamo M et al. Real-world effect of gastroesophageal reflux disease on cough-related quality of life and disease status in asthma and COPD. Allergol Int 2015; 64 (1): 79–83.
3. Пасечников В.Д., Ивахненко О.И., Слинько Е.Н. и др. Гастроэзофагеальная рефлюксная болезнь с атипичными клиническими проявлениями. Гедеон Рихтер в СНГ. 2000; 3: 36–40. / Pasechnikov V.D., Ivakhnenko O.I., Slin'ko E.N. i dr. Gastroezofageal'naia refliuksnaia bolezn' s atipichnymi klinicheskimi proiavleniiami. Gedeon Rikhter v SNG. 2000; 3: 36–40. [in Russian]
4. Dixon MF, Axon ATR. Bile reflux gastritis and Barrett’s esophagus: Further evidence of a role for duodenogastro-oesophageal reflux? Gut 2001; 49: 359–63.
5. Kahrilas P, McColl K, Fox M et al. The acid pocket: a target for treatment in reflux disease? Am J Gastroenterol 2013; 108: 1058–64.
6. Cannon WB. The movements of the stomach, studied by means of the roentgen rays. J Boston Soc Med Sci 1898; 2: 59–66.
7. Hurtz (Hurst) AF. The Sensibility of the Alimentary Canal. London: Oxford University Press, 1911; p. 58–61.
8. Beaumont H, Bennink R, De Jong J et al. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut 2010; 59: 441–51.
9. Kuiken S, van Den Elzen B, Tytgat G et al. Evidence for pooling of gastric secretions in the proximal stomach in humans using single photon computed tomography. Gastroenterology 2002; 123: 2157–8.
10. Hampson FC, Farndale A, Strugala V et al. Alginate rafts and their characterisation. Int J Pharm 2005; 294: 137–47.
11. Hampson FC, Jolliffe IG, Bakhtyari A et al. Alginate-antacid combinations: raft formation and gastric retention studies. Drug Dev Ind Pharm 2010; 36: 614–23.
12. Mandel KG, Daggy BP, Brodie DA et al. Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Aliment Pharmacol Ther 2000; 14: 669–90.
13. Kwiatek MA, Roman S, Fareeduddin A et al. An alginate-antacid formulation (Gaviscon Double Action Liquid) can eliminate or displace the postprandial ‘acid pocket’ in symptomatic GERD patients. Aliment Pharmacol Ther 2011; 34: 59–66.
14. Rohof W, Bennink R, Smout A et al. An alginateantacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2013; 11: 1585–91.
15. Thomas E, Wade A et al. Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate-antacid (Gaviscon Double Action) – a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2014; 39: 595–602.
16. Rohof WO, Bennink RJ, Boeckxstaens GE. Effect of PPI on the size, position and acidity of the postprandial acid pocket. Gastroenterology 2012; 124: S-92.
17. Strugala V, Dettmar PW, Sarratt K et al. A randomized, controlled, crossover trial to investigate times to onset of the perception of soothing and cooling by over-the-counter heartburn treatments. J Int Med Res 2010; 38: 449–57.
18 Peikin SR First. Gastrointestinal Health. First Edition. Harper Perennial (Harper Collins Publishers) 1999: 40.
19 Ткаченко Е.И., Успенский Ю.П., Пахомова И.Г. и др. Гастроэзофагеальная рефлюксная болезнь: новое решение старой проблемы. Consilium Medicum. 2009; 8. / Tkachenko E.I., Uspenskii Iu.P., Pakhomova I.G. i dr. Gastroezofageal'naia refliuksnaia bolezn': novoe reshenie staroi problemy. Consilium Medicum. 2009; 8. [in Russian]
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1. El-Serag HB, Sweet S, Winchester CC, Dent J. Update on the epidemiology of gastro-oesophageal reflux disease: a systematic review. Gut 2014; 63 (6): 871–80.
2. Shirai T, Mikamo M et al. Real-world effect of gastroesophageal reflux disease on cough-related quality of life and disease status in asthma and COPD. Allergol Int 2015; 64 (1): 79–83.
3. Pasechnikov V.D., Ivakhnenko O.I., Slin'ko E.N. i dr. Gastroezofageal'naia refliuksnaia bolezn' s atipichnymi klinicheskimi proiavleniiami. Gedeon Rikhter v SNG. 2000; 3: 36–40. [in Russian]
4. Dixon MF, Axon ATR. Bile reflux gastritis and Barrett’s esophagus: Further evidence of a role for duodenogastro-oesophageal reflux? Gut 2001; 49: 359–63.
5. Kahrilas P, McColl K, Fox M et al. The acid pocket: a target for treatment in reflux disease? Am J Gastroenterol 2013; 108: 1058–64.
6. Cannon WB. The movements of the stomach, studied by means of the roentgen rays. J Boston Soc Med Sci 1898; 2: 59–66.
7. Hurtz (Hurst) AF. The Sensibility of the Alimentary Canal. London: Oxford University Press, 1911; p. 58–61.
8. Beaumont H, Bennink R, De Jong J et al. The position of the acid pocket as a major risk factor for acidic reflux in healthy subjects and patients with GORD. Gut 2010; 59: 441–51.
9. Kuiken S, van Den Elzen B, Tytgat G et al. Evidence for pooling of gastric secretions in the proximal stomach in humans using single photon computed tomography. Gastroenterology 2002; 123: 2157–8.
10. Hampson FC, Farndale A, Strugala V et al. Alginate rafts and their characterisation. Int J Pharm 2005; 294: 137–47.
11. Hampson FC, Jolliffe IG, Bakhtyari A et al. Alginate-antacid combinations: raft formation and gastric retention studies. Drug Dev Ind Pharm 2010; 36: 614–23.
12. Mandel KG, Daggy BP, Brodie DA et al. Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Aliment Pharmacol Ther 2000; 14: 669–90.
13. Kwiatek MA, Roman S, Fareeduddin A et al. An alginate-antacid formulation (Gaviscon Double Action Liquid) can eliminate or displace the postprandial ‘acid pocket’ in symptomatic GERD patients. Aliment Pharmacol Ther 2011; 34: 59–66.
14. Rohof W, Bennink R, Smout A et al. An alginateantacid formulation localizes to the acid pocket to reduce acid reflux in patients with gastroesophageal reflux disease. Clin Gastroenterol Hepatol 2013; 11: 1585–91.
15. Thomas E, Wade A et al. Randomised clinical trial: relief of upper gastrointestinal symptoms by an acid pocket-targeting alginate-antacid (Gaviscon Double Action) – a double-blind, placebo-controlled, pilot study in gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2014; 39: 595–602.
16. Rohof WO, Bennink RJ, Boeckxstaens GE. Effect of PPI on the size, position and acidity of the postprandial acid pocket. Gastroenterology 2012; 124: S-92.
17. Strugala V, Dettmar PW, Sarratt K et al. A randomized, controlled, crossover trial to investigate times to onset of the perception of soothing and cooling by over-the-counter heartburn treatments. J Int Med Res 2010; 38: 449–57.
18 Peikin SR First. Gastrointestinal Health. First Edition. Harper Perennial (Harper Collins Publishers) 1999: 40.
19 Tkachenko E.I., Uspenskii Iu.P., Pakhomova I.G. i dr. Gastroezofageal'naia refliuksnaia bolezn': novoe reshenie staroi problemy. Consilium Medicum. 2009; 8. [in Russian]
Авторы
Г.С.Аникин*
ГБОУ ВПО Первый Московский государственный медицинский университет им. И.М.Сеченова Минздрава России. 119991, Россия, Москва, ул. Трубецкая, д. 8, стр. 2;
ФГБУ Поликлиника №3 Управления делами Президента РФ. 129090, Россия, Москва, Грохольский пер., д. 31
*medi321@mail.ru
________________________________________________
G.S.Anikin*
I.M.Sechenov First Moscow State Medical University of the Ministry of Health of the Russian Federation. 119991, Russian Federation, Moscow, ul. Trubetskaia, d. 8, str. 2;
Out-Patient Сlinic №3 of Administration of the President of Russian Federation of the Ministry of Health of the Russian Federation. 129090, Russian Federation, Moscow, Grokhol'skii per., d. 31
*medi321@mail.ru