Heartburn gets its name from the burning sensation felt behind the sternum in the middle of the chest. Patients may also feel it in their throat. As explained by Cleveland Clinic, patients may also experience a bitter or sour taste in the back of their throat. “Heartburn can last from a few minutes to several hours. It often feels worse after you eat or when you lay down too quickly after eating.”1 

TRIGGERS & TREATMENT 

There are a few medical conditions that can cause reflux and make a patient feel heartburn, including: 

• Pregnancy.
• Hiatal hernia (when the stomach bulges up into the chest). 
• Gastroesophageal reflux disease (GERD). 
• Certain medications (especially anti-inflammatory drugs and aspirin).1 

However, Strugala et al. explained: “Many people experience symptoms of heartburn and regurgitation, indicative of gastro-oesophageal reflux disease, to a mild to moderate extent in response to food. This post-prandial heartburn is often related to specific food triggers such as fatty, spicy, rich, or large meals. The sufferer, realising the lifestyle-related nature of the symptoms and that they are not serious, tends not to consult their general practitioner but purchases an OTC medication to relieve the symptoms. OTC medications for the relief of heartburn include a wide variety of antacids for bulk neutralisation of stomach acid, alginate reflux suppressants that form a raft to suppress reflux, and H2-receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) that pharmacologically block/inhibit acid secretion.2 

https://www.youtube.com/watch?v=ROaPvB2y_lM

“The patient requires the OTC medication for rapid and effective control of the symptoms that they are experiencing. Antacids have a rapid but short-lived effect and H2RAs and PPIs, whilst highly effective, have a long latency before symptom relief is seen. In contrast, alginate raft-forming reflux suppressants have a rapid onset of action with prolonged control of symptoms.”2 

ALGINATES

Alginate-based raft-forming formulations have been marketed word-wide for over 30 years under various brand names according to Mandel et al. “They are used for the symptomatic treatment of heartburn and oesophagitis and appear to act by a unique mechanism which differs from that of traditional antacids.”3 

Savarino et al. explained: “In the presence of gastric acid, alginates precipitate and form a gel. One of the most interesting characteristics is due to the presence of sodium or potassium bicarbonate that, in the presence of gastric acid is converted to a dioxide which, when entrapped in the gel, converts it into a foam that floats on the surface of the gastric contents.”4 Much like a raft on water. 

“Since the alginate-raft needs to float on the gastric contents for effectiveness, the time at which the alginate-based raft-forming formulations is taken is of great importance,” said Mandel et al. “Optimal benefit is achieved when taken following a meal.”3 

Although alginate-based raft products are often categorised among antacids, they are indeed different, Mandel et al. explained. “Unlike traditional antacids which chemically neutralise gastric acid, or histamine H2-receptor antagonists which pharmacologically reduce acid secretion, alginate rafting products appear to act primarily by a physical, rather than a chemical or pharmacological means. This unique mechanism of action provides both the rapid onset of action of conventional antacids and a longer effective duration.”3 

REFERENCES 

• https://my.clevelandclinic.org/health/diseases/9617-heartburn-overview 
• Strugala V, Dettmar PW, Sarratt K, Sykes J, Berry P, Thomas E. A Randomized, controlled, crossover trial to investigate times to onset of the perception of soothing and cooling by over-the-counter heartburn treatments. J Int Med Res. 2010 Mar-Apr;38(2):449-57. doi: 10.1177/147323001003800208. PMID: 20515559. Available from: https://journals.sagepub.com/doi/10.1177/147323001003800208?url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed& 
• Mandel KG, Daggy BP, Brodie DA, Jacoby HI. Review article: alginate-raft formulations in the treatment of heartburn and acid reflux. Aliment Pharmacol Ther. 2000 Jun;14(6):669-90. doi: 10.1046/j.1365-2036.2000.00759.x. PMID: 10848650. Available from: https://pubmed.ncbi.nlm.nih.gov/10848650/ 
• Savarino E, de Bortoli N, Zentilin P, Martinucci I, Bruzzone L, Furnari M, Marchi S, Savarino V. Alginate controls heartburn in patients with erosive and nonerosive reflux disease. World J Gastroenterol. 2012 Aug 28;18(32):4371-8. doi: 10.3748/wjg.v18.i32.4371. PMID: 22969201; PMCID: PMC3436053. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3436053/