From the Guidelines
Sodium alginate is a viable treatment option for hyperacidity, working by forming a protective barrier on top of stomach contents that physically blocks acid from refluxing up into the esophagus. When sodium alginate comes into contact with stomach acid, it reacts to form a viscous gel or "raft" that floats on the surface of the stomach contents. This mechanism is supported by a study published in 2023, which notes that alginate forms a viscous raft that can function as a barrier to reflux in part by neutralizing the acid pocket in the proximal stomach 1.
Key Points About Sodium Alginate
- Sodium alginate can provide quick relief from hyperacidity symptoms, often within minutes of administration.
- It is commonly combined with antacids like calcium carbonate or sodium bicarbonate, which not only neutralize some acid but also enhance the raft formation.
- The standard dosage typically ranges from 10-20 ml of liquid or 2-4 tablets after meals and at bedtime.
- Sodium alginate has minimal side effects compared to other acid-suppressing medications, making it a safe option for long-term use or during pregnancy.
Clinical Evidence
A randomized trial mentioned in the 2023 study showed that in patients with laryngopharyngeal reflux (LPR), alginate resulted in significant improvement of symptoms and laryngeal signs compared with no treatment 1. However, another more recent double-blind, placebo-controlled trial found that symptom improvement and the number of reflux episodes as measured by pH impedance were similar for alginate compared with placebo, suggesting mixed evidence regarding its efficacy 1.
Recommendation
Given the most recent and highest quality evidence, sodium alginate should be considered as part of the treatment regimen for hyperacidity, especially for patients who require quick relief and have concerns about the side effects of other medications. Its use, however, should be tailored to the individual patient's needs and response, considering the mixed evidence regarding its efficacy in certain patient populations 1.
From the Research
How Sodium Alginate Works for Hyperacidity
- Sodium alginate is a medication that works through an alternative mechanism by displacing the post-prandial gastric acid pocket 2
- It is used to treat symptoms of gastroesophageal reflux disease (GERD) and has been shown to be effective in reducing symptoms of mild to moderate GERD 2
- Alginates, including sodium alginate, form a "raft" over gastric contents to reduce acidic reflux episodes and bind to the esophageal mucosa, preserving functional barrier integrity 3
- They have been found to prevent barrier dysfunction and preserve epithelial barrier function during pepsin-acid insult, suggesting that protection is due to alginate 3
Mechanism of Action
- Sodium alginate works by forming a physical barrier over the stomach contents, reducing the amount of acid that can flow back up into the esophagus 2
- It also binds to the esophageal mucosa, preserving functional barrier integrity and preventing mucosal barrier dysfunction 3
- This mechanism of action is different from that of proton pump inhibitors (PPIs) and histamine-2 receptor antagonists (H2RAs), which work by reducing acid production in the stomach 4, 5
Comparison to Other Treatments
- Sodium alginate has been shown to be more effective than placebo or antacids in treating GERD symptoms 2
- However, it appears to be less effective than PPIs or H2RAs, although the pooled estimate was not statistically significant 2
- Alginates, including sodium alginate, may be a useful alternative for patients who do not respond to or cannot tolerate PPIs or H2RAs 2