Gaviscon Advance for Non-Acid Laryngopharyngeal Reflux (LPR)

Over time, I have received a number of emails from patients regarding the best type of Gaviscon Advance they should purchase for relief of NON-acidic laryngopharyngeal reflux (LPR). The blunt answer is to get the Gaviscon Advance Suspension/Liquid made by Reckitt Benckiser which contains at least 500mg of sodium alginate in 5ml dose (1 tsp) or 1 gram in 10cc dose (2 tsps). This formula of Gaviscon Advance cannot be purchased in the United States, but instead overseas via online pharmacies located in the United Kingdom (link). Occasionally, Amazon.comdoes stock it.

The Gaviscon (without the "advance") sold in the United States is manufactured and distributed by GlaxoSmithKline (GSK) and not Reckitt Benckiser. The US brand of Gaviscon by GSK contains less of the key ingredient sodium alginate which helps with NON-acidic reflux. Alginate is a natural product derived from seaweed. The alginate reacts with the acid in the stomach to produce a "raft" barrier that acts as a physical block to reflux. It is the only non-surgical treatment that can physically prevent reflux disease regardless of whether it is acidic or not. Alginates work rapidly, are long lasting, inexpensive, and have no known side-effects.

Background
Non-acidic LPR is when stomach contents other than acid such as mucus, pepsin, bile, and other digestive secretions backflow up to the throat and cause damage. The symptoms include phlegmy/mucus sensation in the throat, constant throat-clearing, dry/irritated throat, globus, chronic cough, etc. Traditional reflux medications like prilosec, prevacid, nexium, zantac, pepcid, etc do NOT help with NON-acidic reflux... those meds ONLY help with acid reflux. Non-acidic reflux is typically diagnosed by 24 hour multichannel pH and impedance testing. Simple 24 hour pH testing (ie, Bravo capsule) will not diagnose this disorder... impedance testing must be included.

Treatment
Initial therapy to treat non-acidic LPR would be to keep the head of bed elevated more than 30 degrees. Best way to do this is by placing 2-3 bricks/books under the legs at the head of the bed to tilt the entire bed. Or, sleep in a chair recliner. Or, purchase a mattress wedge. Sleeping with several pillows is not adequate as one needs the chest region also to be higher than your stomach (not just the head).

Medications that may help include robinul forte, Maalox (less preferable) or Gaviscon Advance made by Reckitt Benckiser (RK) as stated above.

The only known "cure" is a Nissen Fundoplication or LINX surgical procedure performed by general surgeons. Trans-Oral Incisionless Fundoplication (TOIF) is a less invasive option that may help.

References:
An evaluation of the antireflux properties of sodium alginate by means of combined multichannel intraluminal impedance and pH-metry. Aliment Pharmacol Ther. 2005 Jan 1;21(1):29-34

The value of a liquid alginate suspension (Gaviscon Advance) in the management of laryngopharyngeal reflux. Eur Arch Otorhinolaryngol. 2009 Feb;266(2):243-51. Epub 2008 May 28.

The role of an alginate suspension on pepsin and bile acids - key aggressors in the gastric refluxate. Does this have implications for the treatment of gastro-oesophageal reflux disease? J Pharm Pharmacol. 2009 Aug;61(8):1021-8.