Gaviscon for gastro-oesophageal reflux in infants: a poorly effective treatment?

We read with interest the recent article by Del Buono et al evaluating the effect of sodium and magnesium alginate (Gaviscon) on gastro-oesophageal reflux (GOR) in infants. It provides an objective assessment of the effects of a drug widely used in the treatment of paediatric GOR by means of a double blind drug versus placebo trial, in which the effects of each treatment were evaluated by means of the simultaneous application of multichannel intraluminal impedance and pH-metry (MII/pH). The authors show that Gaviscon reduces this height, probably because it increases the viscosity of the gastric content and hence acts in the same way as thickened feeding. They also found that fewer acid reflux episodes occurred after Gaviscon, though the difference was not significant. By contrast with the evidence produced in other studies, therefore, these results seem to suggest that Gaviscon Infant has little effect on GOR when assessed in objective terms. It is, however, possible that the significance of some of the differences they observed has been weakened by the influence of sleep and wakefulness on GOR episodes.