Intermittent and on-Demand Use of Proton Pump Inhibitors in The Management of Symptomatic Gastroesophageal Reflux Disease

Bardhan, Karna Dev

doi:10.1016/s0002-9270(03)00014-5

Cited by 44 publications

(39 citation statements)

References 35 publications

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“…A continuous use of PPIs is not necessary in many patients [8]. In a proportion of patients (60%) with mild symptoms of GERD, several studies have shown that on-demand or intermittent therapy with PPIs is efficacious [40]. On-demand therapy is a patient-centered approach to GERD and a cost-effective one when PPIs are used [41].…”

Section: Optimizing Therapy Of Gerdmentioning

confidence: 99%

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

et al. 2007

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Proton pump inhibitors (PPIs) are antisecretory agents that are widely used in the short- and long-term management of gastroesophageal reflux disease (GERD) to relieve symptoms, heal esophagitis, and prevent complications, such as strictures and Barrett’s esophagus. The total healthcare costs of GERD are high, especially for maintenance treatment. Therefore, the choice of cost-effective therapeutic options is an ineluctable challenge for public health authorities, third-party payers, and patients. In some European Union countries, a recent trend of public health authorities is to promote the choice of less expensive PPIs, regardless of their antisecretory potency – this in spite of the evidence that newer PPIs provide superior symptom relief and esophageal erosion healing compared to earlier drugs. Several large clinical trials have demonstrated the superiority of esomeprazole over other PPIs at standard doses for both initial and continuous maintenance therapy in patients with moderate/severe erosive esophagitis. The non-erosive GERD poses a major challenge as this condition appears more frequently to be less responsive to PPIs. The use of PPIs with the strongest antisecretory properties might reveal to be more adequate and cost-effective, particularly for this indication.

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Section: Optimizing Therapy Of Gerdmentioning

confidence: 99%

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

et al. 2007

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“…Research demonstrates that up to 80% of presumed GERD patients on continuous PPI treatment can be stepped-down to less intensive therapy, such as dosage reduction, on-demand or intermittent therapy [11,12,13]. …”

Section: Introductionmentioning

confidence: 99%

Pharmacological Dependency in Chronic Treatment of Gastroesophageal Reflux Disease: A Randomized Controlled Clinical Trial

Velden

Wit²,

Quartero³

et al. 2009

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Background: Despite evidence of the overuse of acid suppressive medication for gastroesophageal reflux disease (GERD), a transfer to noncontinuous therapy after long-term treatment proves difficult. Aim: To quantify the effect of blinded dosage reduction after long-term therapy on symptom control and quality of life while assessing pharmacological and placebo needs. Methods: Primary care patients with a history of GERD and long-term treatment were randomized to daily placebo with pantoprazole rescue (n = 141) or daily pantoprazole with placebo rescue (n = 62) upon relief after 4 weeks pantoprazole 20 mg. The number of rescue tablets, symptom control and generic quality of life were analyzed. Results: Measured from the daily placebo arm, 19% of the patients terminated treatment, 33% managed with 2–6 tablets/week, 38% needed a daily dosage and 10% needed more than a daily dosage in the long run. At these final dosages, symptom control and quality of life were dosage-independent and, furthermore, equal to values of patients on fixed daily pantoprazole. A temporal decrease in well-being was seen in 24% of the patients. Conclusion: A significant placebo response is apparent in long-term users of acid suppressive medication and pharmacological dependency is overestimated. Despite their history of long-term treatment, the majority of GERD patients can be switched from daily to on-demand treatment without impairing symptom control and quality of life.

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“…Besides healing of the esophagus, the aim of a therapeutic intervention for GERD should not only be to reach rapid, but also sustained symptom relief. Evaluations of the phase after initial treatment are done in the context of long-term treatment, e.g., continuous [13,14,15] or on-demand treatment [16, 17]. These studies often define a relapse as the recurrence of mucosal damage determined in an endoscopy at a predefined time point [29, 30] or when symptoms seem to suggest a relapse after 3 consecutive days of GERD symptoms [14, 31].…”

Section: Discussionmentioning

confidence: 99%

“…This results in a high rate of relapses after successful treatment, when the intake of medication is stopped. Relapses occur in about 70% of all patients within 6 months after initial medication [12,] resulting in the necessity of long-term (maintenance) treatment which is often given as continuous treatment [13,14,15] or as on-demand treatment [16, 17]. …”

Section: Introductionmentioning

confidence: 99%

Pantoprazole 40 mg Is as Effective as Esomeprazole 40 mg to Relieve Symptoms of Gastroesophageal Reflux Disease after 4 Weeks of Treatment and Superior regarding the Prevention of Symptomatic Relapse

Glatzel

Abdel-Qader

Gatz³

et al. 2007

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Background/Aim: Little is known about the symptom course during and after treatment of gastroesophageal reflux disease (GERD). Here we address this question in patients with erosive GERD treated with pantoprazole or esomeprazole 40 mg once daily using the validated reflux questionnaire ReQuest^TM. Methods: Of 585 patients enrolled, 561 (intention-to-treat; ITT) patients with endoscopically confirmed GERD grades A–D (Los Angeles Classification) were randomized. To assess the GERD symptomatology, the patients completed the ReQuest daily, and analysis was done prior to (7 days), during (28 days), and after treatment (7 days). The mean scores (last 3 treatment days) of the subscale ReQuest^TM-GI (gastrointestinal complaints) were compared between both groups. After the end of treatment, the number of symptom episodes and the rate of relapses were calculated. Results: Noninferiority of pantoprazole versus esomeprazole during treatment was shown (mean ReQuest-GI score). During the posttreatment period, the proportion of patients experiencing a symptomatic relapse (51 vs. 61%, p = 0.0216, ITT) and the number of symptom episodes (0.56 vs. 0.74, p = 0.0095, ITT) were significantly lower on pantoprazole than on esomeprazole. Conclusions: Pantoprazole 40 mg was at least as effective as esomeprazole 40 mg for relieving GERD symptoms. During the posttreatment phase, patients on pantoprazole had a significantly lower risk to relapse and experienced significantly fewer symptom episodes.

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Intermittent and on-Demand Use of Proton Pump Inhibitors in The Management of Symptomatic Gastroesophageal Reflux Disease

Cited by 44 publications

References 35 publications

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

Potential Options to Optimize Therapy of Gastroesophageal Reflux Disease with Proton Pump Inhibitors

Pharmacological Dependency in Chronic Treatment of Gastroesophageal Reflux Disease: A Randomized Controlled Clinical Trial

Pantoprazole 40 mg Is as Effective as Esomeprazole 40 mg to Relieve Symptoms of Gastroesophageal Reflux Disease after 4 Weeks of Treatment and Superior regarding the Prevention of Symptomatic Relapse

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