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 SIMALGEL FOR TREATMENT OF GASTROESOPHAGEAL REFLUX DISEASE 
T. IOSELIANI - Medical Doctor
Head of the Department of Endoscopy
in the Clinical Medical Institute of Science and Research
 
 
Gastroesophageal disease (GERD) comprise unity of symptoms that is accompanied by inflammatory changes in the mucosa of distal esophagus. The main cause of this changes is regurgitation of stomach and duodenal contents into the esophageal lumen. In mild cases catarrheal inflammatory changes take place in the distal third of esophagus and in severe forms peptic lesions like erosions and ulcers occur.
 
GERD is widely spread all over the world and occur in 40% of the world population, also widely based clinical trials held at U.S.A. and western European countries showed that 40% of adult population constantly suffer of heartburn, which is the main symptom of GERD. The trials held in Russia showed that 40-60% of population have GERD.
 
GERD is considered as an acid dependent disease although one of it,s causes is insufficiency of the lower esophageal sphincter.
 
The main causes of GERD:
1.      Disturb of the antireflux barriers
2.      Decreased esophageal clearance, mainly caused by weakend peristaltic waves and reduced of acid neutralizing action of saliva and bicarbonates.
3.      Damaging action of refluxed materials.
4.      Decrease of esophageal resistance against refluxed materials.
5.      Problems with gastric empting.
6.      Increased intraabdominal pressure
 
The main symptoms of GERD are: heartburn, belching, mouthwash, vomiting, dysphagia and odynophagia. Such signs are mainly expressed at night hours and may also be triggered by irregular dieting, by acidic and spicy food and alcohol.
 
Pain in the epigastric region near the xiphoid process is also the main symptom , usually occurring after meals and aggravated by leaning forward. It is important to differentiate such pain from angina pectoris. Differential diagnosis should be made between simple esophagitis, cardial ring insufficiency and hiatal hernia.
 
Diagnosis is made by x-ray contrast studies, pH-metry and importantly by endoscopic studies. Via endoscopy stages of gastric and esophageal lesions can be evaluated, also catarheal, erosive and ulcerated lesions can be differentiated, which is crucial for choosing the right treatment regimens.
 
Among the complications of GERD are esophageal strictures and Barett’s esophagitis development with intestinal metaplasia, wich malignant potential in 8% of cases causes carcinomatosis. Bleeding is one of among the complications of GERD.
 
Treatment of GERD starts with life-style modification. Acidic, spicy and bitter food, garlic, onion, pepper, chocolate, fizzy drink and alcohol are forbidden. Meals should be frequent and small usually in every 4-5 hours. The last meal should be 3-4 hours before bedtime and sleeping on high-pillowed beds are also recommended.
 
For mild and moderate forms of GERD antacids and alkinates are mainly prescribed. That’s why we mainly use SIMALGEL as antacid medication. Each 5ml suspension of SIMALGEL contains 405 mg of aluminium hydroxide dry gel, 100 mg of magnesium hydroxide and 125 mg of Simeticone. Such combination gives the medication effective acid neutralizing and adsorbing properties.
 
SIMALGEL maintains gastric acidity in pH range of 4.0; doesn’t cause secondary hypersecretion; has rapid painkilling effect; doesn’t produce gas via neutralization reaction apart from other antacids; doesn’t has systemic effects because it is local agent; doesn’t disturb with acid-base balance.
 
SIMALGEL’s antiflatus component - Simeticone – positively influence dyspeptic complaints of not only GERD disease but also in other inflammatory and functional disorders. Generally Simeticone interferes with gas formation in GI tract, lower intra-gastric and intraabdominal pressure and interfere with growth of Helicobacter pylori .
 
SIMALGEL’s main action is that it creates tiny foam layer on gastric mucosa and in case of reflux it neutralizes acid in the esophagus. It creates protective layer on the esophageal mucosa and interferes with the damaging action of refluxate.
 
SIMALGEL is also effectively used in gastric and duodenal ulcerative disease, acute and chronic gastritis, gastroenteritis and colitis, inflammatory bowel diseases, cholecystitis, postcholecystectomy associated derangements and so on. It is important to note that SIMALGEL is effective in bile reflux disease too when acidity of the refluxate is not high.
 
SIMALGEL dosing and regimen: In adults 10-15ml 3-4 times a day 30 min before meals or 1-1.5 hours after meals. For symptomatic treatment 10-15ml - 2 times a day. In children older 10 years half the adult doses are used. Time interval between SIMALGEL and other medications should be 2 hours. Menthol aroma of the suspension makes it easy to be taken orally.
 
The medication should be used with caution in liver and renal insufficiencies , in Alzhaimer’s disease and muscle-skeletal disorders.
 
We have studied SIMALGEL efficiency in more than 1000 patients and found out that it is effective not only in GERD but in other GI inflammatory and functional disorders.
 
In severe cases of GERD and in case of its complications, proton pump inhibitors (pantoprasole (UlSEPAN), lansoprasole, rabeprasole and prokinetics (Doprokin) are used. Using multi-drug regimens GERD can be effectively treated but continuous clinical monitoring, healthy life-style and eating-habit modification is also very important.
 
Literature:
 
1. ფ. თოდუა, თ. იოსელიანი, მ. გურგენიძე ,,საყლაპავიმილის, კუჭისადა 12-გოჯანაწლავისენდოსკოპიისატლასი”. ქ. თბილისი, 2000 წ. გვ. 12

2. ,,კუჭისადა 12-გოჯანაწლავისწყლულოვანდაავადებათადაგასტროეზოფაგურირეფლუქს - დაავადებისდიაგნოსტიკისადამკურნალობისთანამედროვეპრინციპები” - საქართველოსგასტროენტეროლოგთადაჰეპატოლოგთასამეცნიეროასოციაციისმიერმოწოდებულიმეთოდურირეკომენდაციები; ქ. თბილისი, 2006 წ. გვ. 36

 
3. Черноусов А. Ф. , Шестаков А. Л. , Тамазян Г. С. ,, Рефлюкс-эзофагит”, г. Москва, 1999 г. ст. 135
 
4.      Ивашкина В.Т. , Трухманова А.С. ,,Болезни пищевода”, г. Москва, 2000 г. ст. 179
 
5.       Оковитый С. В., Гаиворонская В.В. ,,Клиническая фармакология антацидных средст”. Фарминдекс-Практик,выпуск 7, 2005 г. ст. 3-12
 
6.      Харкевич Д. А. ,,Фармакология”, 2005 г. ст. 362
 
7.      Mital R. K. Meccallum et all. ,,Identification and mechanismus of Delayed Oezophageal Clearance in subjects with hiatal hernia”. Gastroenterology, 1987. 92. Pages 130 - 135