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In the Clinic |

Gastroesophageal Reflux Disease

Ian G. Harnik
[+] Article, Author, and Disclosure Information

CME Objective: To review current evidence for diagnosis, treatment, practice improvement, and patient information for gastroesophageal reflux disease.

Funding Source: American College of Physicians.

Disclosures: Dr. Harnik, ACP Contributing Author, has disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0359.

Ann Intern Med. 2015;163(1):ITC1. doi:10.7326/AITC201507070
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This issue provides a clinical overview of gastroesophageal reflux disease, focusing on diagnosis, treatment, and practice improvement. The content of In the Clinic is drawn from the clinical information and education resources of the American College of Physicians (ACP), including ACP Smart Medicine and MKSAP (Medical Knowledge and Self-Assessment Program). Annals of Internal Medicine editors develop In the Clinic from these primary sources in collaboration with the ACP's Medical Education and Publishing divisions and with the assistance of science writers and physician writers. Editorial consultants from ACP Smart Medicine and MKSAP provide expert review of the content. Readers who are interested in these primary resources for more detail can consult http://smartmedicine.acponline.org, http://mksap.acponline.org, and other resources referenced in each issue of In the Clinic.


Grahic Jump Location
Figure 2.

Diagnosis and management of GERD.

ENT = ear, nose, and throat; PPI = proton-pump inhibitor.

* Assumes no alarm signs and no increased risk for Barrett esophagus (esophagogastroduodenoscopy is recommended if present).

† Indefinite maintenance with PPI for severe erosive disease, Barrett esophagus, or peptic stricture.

Grahic Jump Location




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Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).


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Sodium alginate is no longer available in OTC medications
Posted on July 22, 2015
Glen D. Solomon, MD
Professor and Chair, Dept. of Internal Medicine, Wright State University
Conflict of Interest: None Declared
The table of medical therapy for GERD lists the surface barrier sodium alginate (with antacid) as a treatment option. The combination of sodium alginate plus an antacid was sold for many years as the brand Gaviscon. In the United States, the OTC product Gaviscon has been reformulated and no longer contains sodium alginate. In Europe, Gaviscon Double-Strength Liquid continues to contain sodium alginate plus an antacid. There are no OTC products in the United States that contain sodium alginate.
Reply to Solomon
Posted on August 31, 2015
Ian G. Harnik
Montefiore Medical Center, Bronx, NY
Conflict of Interest: None Declared
I thank Dr. Solomon for his comments regarding medical therapy for GERD. As he notes, sodium alginate is no longer available in high concentrations in the formulations sold in the United States as Gaviscon (R), produced by GlaxoSmithKline, where it is simply listed as an inactive ingredient. This is in contrast to alternative formulations such as Gaviscon Advance (R) and Gaviscon Double Action (R) manufactured by Reckitt Benckiser which are available commercially in Europe, India and Australia. The latter products provide 500-1000mg of sodium alginate per dose, which is similar to that used in some studies suggesting alginate's efficacy (1).

1. Chiu CT, Hsu CM, Wang CC, et al. Randomised clinical trial: sodium alginate oral suspension is non-inferior to omeprazole in the treatment of patients with non-erosive gastroesophageal disease. Aliment Pharmacol Ther. 2013 Nov;38(9):1054-64
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