Journal
JOURNAL OF NEUROGASTROENTEROLOGY AND MOTILITY
Volume 28, Issue 1, Pages 5-14Publisher
KOREAN SOC NEUROGASTROENTEROLOGY & MOTILITY
DOI: 10.5056/jnm21095
Keywords
Gastroesophageal reflux; Maintenance; Proton pump inhibitors
Categories
Funding
- Korea Health Technology R&D Project through the National Evidence-based Healthcare Collaborating Agency (NECA) - Ministry of Health & Welfare, Republic of Korea [HI19C0481, HC19C0060]
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On-demand PPI therapy shows comparable efficacy to continuous maintenance treatment in GERD patients. For non-erosive esophageal reflux disease and mild erosive reflux disease patients, on-demand therapy can remarkably reduce the amount of PPI use.
Background/Aims Long-term maintenance treatment of gastroesophageal reflux disease (GERD) is commonly used to prevent relapse of reflux symptoms; however, due to concerns about safety of long-term proton pump inhibitors (PPI) use, on-demand therapy is recommended as a long-term treatment modality. We compared the efficacy of on-demand and continuous PPI therapy for maintenance treatment of patients with GERD using meta-analysis. Methods Core electronic databases were searched for randomized controlled trials comparing on-demand and continuous therapy in GERD patients. The primary outcome was treatment failure of maintenance therapy, and the secondary outcomes included symptomatic relief, patient satisfaction, and amount of PPI use. Results Overall, 11 studies were selected in the systematic review and meta-analysis. Compared with continuous PPI therapy, on-demand therapy showed similar outcomes for treatment failure (risk ratio, 1.26; 95% confidence interval [CI], 0.76-2.07), particularly in the non-erosive esophageal reflux disease and mild erosive reflux disease group (risk ratio, 1.48; 95% CI, 0.39-5.63). In studies including severe esophagitis patients, continuous PPI maintenance treatment was more effective (beta, 0.127 [95% CI, 0.066-0.188]; P < 0.001). Severity of esophagitis was associated with higher efficacies of continuous maintenance therapy. The amount of daily PPI use was about half in the on-demand group compared to the continuous group (risk difference -0.52; 95% CI, -0.62--0.42). Conclusions On-demand PPI therapy shows comparable efficacy to the continuous maintenance treatment in the non-erosive esophageal reflux disease and mild erosive reflux disease group, and can remarkably reduce the amount of PPI use. Therefore, on-demand therapy may be preferentially recommended in the maintenance treatment of GERD unaccompanied by severe esophagitis.
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