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For maintenance therapy of GERD unaccompanied by severe esophagitis, the on-demand proton pump inhibitors may be preferentially recommended.
In a recent study, the on-demand proton pump inhibitors maintenance demonstrated equivalent effectiveness to the continuous proton pump inhibitors maintenance in gastroesophageal reflux disease (GERD) people, particularly in mild erosive reflux disease and non-erosive esophageal reflux disease. In comparison with continuous therapy, the on-demand therapy exhibited the advantage of minimizing the amount of proton pump inhibitors usage by half.
In this systematic review and meta-analysis, investigators evaluated the efficacy of on-demand and continuous proton pump inhibitors therapy for maintenance therapy of people having GERD. The core electronic databases (EMBASE, the Cochrane library, KoreaMed, PubMed) were explored for the relevant randomized controlled trials evaluating on-demand and continuous therapy in GERD people.
Treatment failure of maintenance therapy (premature discontinuation of the allocated therapy) was the major endpoint while patient satisfaction, percentage of people attaining symptomatic relief, adverse events, and amount of proton pump inhibitors usage were the secondary endpoints. The study incorporated 11 studies. In comparison with continuous treatment, the on-demand treatment demonstrated comparable outcomes for therapeutic failure (risk ratio, 1.26), especially in the mild erosive reflux disease group and non-erosive esophageal reflux disease (risk ratio, 1.48).
The continuous proton pump inhibitors maintenance therapy showed higher efficacy in studies including severe esophagitis people. The esophagitis severity was linked with greater effectiveness of continuous maintenance treatment. In comparison with the continuous group, the amount of daily proton pump inhibitors usage was about half in the non-demand group (risk difference -0.52).
Thus, the on-demand proton pump inhibitors therapy appears to be an efficacious maintenance treatment modality in people with GERD unaccompanied by severe esophagitis.
Journal of Neurogastroenterology and Motility
On-demand Versus Continuous Maintenance Treatment of Gastroesophageal Reflux Disease With Proton Pump Inhibitors: A Systematic Review and Meta-analysis
Seung Joo Kang et al.
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