Sodium alginate 500mg / Potassium bicarbonate 100mg chewable tablets sugar free

Background and objectiveErosive esophagitis (EE) is the second most common phenotype of gastroesophageal reflux disease (GERD). While proton pump inhibitors (PPIs) are considered the mainstay treatment for healing and maintaining remission of EE, a significant proportion of patients, particularly those with advanced grades, fail to respond adequately. This review provides an updated overview of the current pharmacological treatment options for EE.MethodsAn extensive electronic literature search was performed using PubMed database to identify relevant articles. The search included prospective clinical trials, observational trials, case-control studies, systematic reviews with or without meta-analysis, and narrative reviews describing pharmacological therapy for adult patients with EE. Articles were limited to English language publications. Search terms encompassed various treatment modalities including PPIs, potassium-competitive acid blockers (P-CABs), histamine 2 receptor antagonists (H2RAs), sucralfate, prokinetics, rebamipide and alginates.Key content and findingsResearch has shown varying effectiveness across different treatments for EE. While randomized controlled trials found alginates, sucralfate, and histamine-2 receptor antagonists to have limited healing efficacy, PPIs remain the most effective treatment, achieving healing rates of 75-95% after 8 weeks, though symptom resolution reaches about 60-85%. Among PPIs, esomeprazole shows slightly better healing outcomes compared to others. However, PPI effectiveness decreases in advanced EE cases [Los Angeles (LA) grades C/D], with healing rates dropping to 60-70%. More recently, P-CABs have demonstrated promising results, demonstrating healing rates non-inferior to PPIS but superior in patients with advanced EE or PPI-resistent EE. Given that most patients experience relapse upon discontinuation, maintaining PPI or PCAB therapy is crucial for preventing EE recurrence.ConclusionsThe future of EE management lies in a more personalized approach that takes into account disease severity, PPI response, and patient preferences. While PPIs remain the mainstay of treatment, P-CABs represent a promising new therapeutic option, particularly for severe and PPI-resistant cases. The addition of nighttime to bedtime H2RAs or use of double PPI dose may benefit refractory cases. Further studies are needed to directly compare PPIs and P-CABs in different EE grades and evaluate the value of adjunctive therapies.

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Phage therapy has enormous potential in combating bacterial resistance in food animals. However, its application via the oral route remains limited due to challenges associated with the gastrointestinal tract (GIT) environment and a lack of rigorous clinical trial evidence. Therefore, we systematically searched in Google Scholar, PubMed, Scopus, and Web of Science databases following PRISMA guidelines and finally identified 111 articles on oral phage therapy in food animals from where we summarized the key physiological and chemical factors of the gut environment hindering the effectiveness of oral phage therapy (OPT), examined the methods used to evaluate phage stability in the GI environment, and highlighted potential strategies to mitigate these challenges. In addition, we performed quantitative analysis to visualize in vitro pH and thermal stability patterns of phages targeting bacteria isolated from food animals and variability in buffer and incubation period across stability studies. The GIT consists of several anatomically and functionally distinct segments, where complex interactions occur among digestive enzymes, gastric acids, electrolytes, commensal microbiota, and mucosal immune components. The acidic pH of the stomach is a major barrier to successful oral phage delivery. According to our analysis of pH stability testing data from the reviewed studies, most phages targeting antimicrobial-resistant bacteria in food animals remained stable at pH 5-9 and inactivated under highly acidic (pH ≤ 2) or highly alkaline (pH ≥ 11) conditions. In addition, phages are susceptible to high temperatures (above 60 °C), digestive enzymes (e.g., pepsin, trypsin, lipases), bile salts, and host immune responses. Several in vitro laboratory techniques are available to assess phage stability under simulated GI conditions, but variations occur in the assessment protocols. Microencapsulation using alginate and chitosan has been used to protect phages from the adverse GI environment. Additionally, enteric-coated capsules, antacids, co-encapsulation with acid-neutralizing agents, consumption of alkaline water, and daily phage administration are suggested to improve phage survival and efficacy. For the successful clinical implementation of OPT in food animals, future research should focus on elucidating the molecular and physicochemical determinants of phage stability, understanding the humoral immune response to OPT, standardizing laboratory protocol for assessing phage viability, improving the scalability of encapsulation methods, and exploring other potential delivery techniques.

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BACKGROUND: While rare, radiological and nuclear (RN) emergencies pose complex challenges that require tailored preparedness strategies. A key aspect is the strategic stockpiling of medical countermeasures (MCMs), yet existing literature offers limited and fragmented recommendations regarding their appropriate composition. METHODS: This systematic review, conducted following PRISMA guidelines, aims to consolidate and critically appraise available evidence on stockpiling for RN emergencies. Seven databases and selected grey literature sources were screened from 2011 onward. Studies were included if they provided direct or indirect recommendations on stockpiling items. Data extraction was conducted in two steps by independent pairs of reviewers, and identified items were categorized as therapeutics, medical devices, personal protective equipment (PPE), or RN-specific equipment. Items were further analyzed for regulatory status, administration route, shelf-life, and storage requirements. RESULTS: Thirty-two articles met the inclusion criteria. Therapeutics dominated the findings, with 50 distinct agents identified, most frequently potassium iodide, Prussian Blue, Ca-/Zn-DTPA, and hematopoietic growth factors such as filgrastim. In contrast, medical devices were not supported by a sufficient level of stockpiling recommendation, while PPE (6 of 32 articles) and RN equipment (14 of 32 articles) were cited less often. Pediatric considerations were rarely addressed, with 2 studies explicitly focused on this population. Gaps in operational guidance, regulatory harmonization, and standardized planning emerged across the literature. CONCLUSIONS: This review highlights that stockpiling recommendations for RN emergencies remain limited, with greater guidance concentrated on a few therapeutics and little direction for other items. The findings provide an informative evidence base to support more consistent policy and preparedness planning.

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IntroductionPersistent throat symptoms (PTS) are indicators for over 60 000 new patient referrals to NHS secondary care annually. PTS have been attributed to manifestation of gastro-oesophageal reflux disease (GORD) with the hypothesis that gastric refluxate damages and irritates the mucosa of the upper aerodigestive tract. Symptoms of PTS and GORD are commonly treated with proton pump inhibitors (PPIs) or alginates are often, incorrectly, advocated. The Trial of PPIs in Throat Symptoms trial definitively demonstrated that lansoprazole is no more effective than placebo in treating symptoms of PTS, indicating that empirical PPI treatment for PTS should be discouraged. The impact of this is an anticipated increase in prescriptions of alginates for PTS, however, there is a lack of evidence of the efficacy of alginates in treating this condition. Trial of alginates in throat symptoms aims to compare symptomatic response of the symptoms of PTS in liquid alginate (Gaviscon Advance) in comparison to a near matched placebo over an 8-week period to provide definitive evidence of the use of alginates in treating PTS.Methods and analysisThis is a multicentre, pragmatic, double blind, parallel, randomised controlled trial. 250 adults with PTS will be recruited from NHS secondary care sites and randomised to either liquid alginate (Gaviscon Advance) or near matched placebo in a 1:1 ratio. The primary objective is to compare the symptomatic response in patients with PTS to liquid alginate (Gaviscon Advance) compared with placebo using the outcome measure of total Reflux Symptom Index questionnaire score at 8 weeks.Ethics and disseminationFavourable ethical opinion was received from the East Midlands-Leicester South Research Ethics Committee (reference: 22/EM/0205). All participants will provide informed consent prior to any trial specific activity taking place. Results will be disseminated in peer reviewed publications, at national and international conferences, in peer reviewed journals and to participants and the public (using lay language).Trial registration numberISRCTN13949559.

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