Insights & Discussion
Pantoprazole magnesium, administered once daily, is effective and well-tolerated in significantly improving symptoms of gastroesophageal reflux disease.
The study was designed as a phase IV, open-label, prospective, multicenter trial where patients who had a history of persistent or recurrent heartburn and/or acid regurgitation for a minimum of three months were prescribed pantoprazole magnesium 40mg orally, once daily for approximately one month. The baseline characteristics and demographics of gastroesophageal reflux disease symptom intensity were recorded and analyzed among thousands of patients who met all inclusion criteria.
Patients' symptoms, assessed by the physician using a 4-point Likert scale, showed considerable reduction from baseline intensity following the treatment. The treatment had a high tolerance rate with very few patients experiencing any adverse events, thereby indicating that pantoprazole magnesium is not only an effective but also a safe drug for patients suffering from gastroesophageal reflux disease.
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Bicarbonate-rich mineral water “Staatl. Fachingen STILL” significantly reduces heartburn more effectively than placebo, improving patients’ quality of life.
2023 BMJ Open Gastroenterology Heartburn relief with bicarbonate-rich mineral water: results of the randomised, placebo-controlled phase-III trial STOMACH STILL Labenz J, Anschütz M, Walstab J, Wedemeyer RS, Wolters H, Schug B
Randomised Controlled Trial GERD Mineral Water
The STOMACH STILL trial, a multicentre, double-blind, randomized, placebo-controlled study, assessed the effectiveness of Staatl. Fachingen STILL mineral water in relieving heartburn. Adult patients with frequent heartburn episodes for at least six months, but without severe reflux oesophagitis, were recruited. They consumed 1.5 liters per day of either the mineral water (verum) or placebo for six weeks. Primary endpoint was a reduction of at least five points in the Reflux Disease Questionnaire score for heartburn. Secondary endpoints included overall symptom reduction, health-related quality of life measures (QOLRAD), rescue medication intake, and safety/tolerability.
Of the 148 patients randomized, 143 completed the trial. The responder rate was significantly higher in the mineral water group (84.72%) compared to the placebo group (63.51%). Significant improvements were observed in the ‘heartburn’ dimension and overall Reflux Disease Questionnaire scores for the mineral water group. Additionally, three out of five Quality of Life in Reflux and Dyspepsia domains showed improvement: ‘food/drink problems,’ ‘emotional distress,’ and ‘vitality.’ The verum group also reported a decrease in rescue medication use. Only three patients experienced treatment-related adverse events. The study concluded that Staatl. Fachingen STILL mineral water is superior to placebo in relieving heartburn and enhancing health-related quality of life.
Alginate, as a treatment option for laryngopharyngeal reflux, is equally effective as proton pump inhibitors and may serve as a potential alternative treatment.
2022 European Archives of Oto-Rhino-Laryngology Magnesium alginate versus proton pump inhibitors for the treatment of laryngopharyngeal reflux: a non-inferiority randomized controlled trial Pizzorni N, Ambrogi F, Eplite A, Rama S, Robotti C, Lechien J, et al.
Randomised Controlled Trial GERD
Researchers employed a non-inferiority randomized controlled trial with fifty participants, all of whom exhibited laryngopharyngeal symptoms. They were divided into two treatment groups; one group received the alginate suspension Gastrotuss in three daily doses, while the other was administered Omeprazole once daily. The Reflux Symptom Index and Reflux Finding Score were used to measure the severity of symptoms both before the treatment and after the two-month treatment period.
It was found that both groups had similar Reflux Symptom Index and Reflux Finding Score values initially. After the two-month treatment, both groups demonstrated significant decrease in these indices, suggesting that the symptoms and signs of laryngopharyngeal reflux were significantly reduced, regardless of the treatment given. The difference between the changes in both Reflux Symptom Index and Reflux Finding Score from the two groups was found to be insignificant, thereby indicating that the effectiveness of Alginate is non-inferior to Proton Pump Inhibitors.
Ginger, peppermint and caraway oil combination showed strong effectiveness in managing upper gastrointestinal complaints, with melatonin and marine alginate demonstrating moderate evidence.
2022 Nutrients Effectiveness of Nutritional Ingredients on Upper Gastrointestinal Conditions and Symptoms: A Narrative Review Schulz RM, Ahuja NK, Slavin JL
Review Article GERD
The methodology consisted of a literature review of the scientific studies pertaining to nutritional ingredients for upper gastrointestinal relief. The selection was based on recurring mentions within the literature and frequent appearance in consumer products. A predefined search for specific nutritional ingredients and terms related to upper GI health was conducted in five databases - Embase, Medline, Derwent drug file, ToXfile, and PubMed. A manual search was also undertaken for each ingredient to ensure comprehensive review.
The studies that gained inclusion encompassed 16 human clinical trials assessing nine different ingredients. The products investigated were divided into categories, including botanicals - with sub-categories of fiber and combinations, and non-botanical extracts. Several products demonstrated good potential, others showed promising but moderate results, while some had limited support from the scientific research.
Positive effects of acupuncture and electroacupuncture were observed in regulating gastric motility, gastric accommodation, mental status, gastrointestinal hormones, and central and autonomic functions while improving dyspeptic symptoms and quality of life.
2020 World Journal of Gastroenterology Effects and mechanisms of acupuncture and electroacupuncture for functional dyspepsia: A systematic review Guo Y, Wei W, Chen JD
GERD Indigestion
In this systematic review, we pooled randomized controlled trials with mechanistic investigations of acupuncture or electroacupuncture in improving dyspeptic symptoms, and illustrated the existing results that may provide potential explanations for the therapeutic effects. The findings of included studies in this review suggest that acupuncture and electroacupuncture can improve gastric motility and accommodation, regulate gastrointestinal hormones and mental status, and alter certain central and autonomic functions in patients with functional dyspepsia. However, due to limitations in the included articles, high-quality studies with well-planned designs and multiregional investigations are necessary to provide more convincing and credible evidence.
Patients receiving acupuncture combined with western medicine had a superior global symptom improvement compared with those receiving western medicine alone for gastro-oesophageal reflux disease.
2017 Acupuncture in Medicine Acupuncture for the treatment of gastro-oesophageal reflux disease: a systematic review and meta-analysis Zhu, J., Guo, Y., Liu, S., et al.
Systematic Review Digestive Health GERD
A total of 12 trials involving 1235 patients were included. Meta-analyses demonstrated that patients receiving MA/EA combined with WM had a superior global symptom improvement compared with those receiving WM alone with no significant heterogeneity. Recurrence rates of those receiving MA/EA alone were lower than those receiving WM with low heterogeneity, while global symptom improvement (six studies) and symptom scores (three studies) were similar. Descriptive analyses suggested that acupuncture also improves quality of life in patients with GORD.
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