On-demand versus half-dose continuous therapy with esomeprazole for maintenance treatment of gastroesophageal reflux disease

Abstract

Background and aims:No consensus has been established regarding optimal long-term maintenance therapy in symptomatic gastroesophageal reflux disease (GERD). The aim of this study was to compare the efficacies of on-demand and continuous therapy with esomeprazole as maintenance treatments for GERD.Methods:Patients with upper gastrointestinal (GI) endoscopy-proven GERD who received initial proton pump inhibitor (PPI) therapy for 8 weeks were randomized to an on-demand group (esomeprazole 40 mg) or a continuous group (esomeprazole 20 mg). Intensities and frequencies of heartburn and acid regurgitation were assessed using a 6-point Likert scale (0 = no symptoms; 5 = very severe symptoms) and a 6-point frequency scale (0 = none; 5 = symptoms for > 5 days per week) at baseline (start of maintenance treatment) and after 12 weeks of treatment. Alleviation of symptoms was quantified using percentages of patients with a Likert scale or frequency scale of 0 or 1.Results:Of the 88 patients enrolled, 8 patients were excluded due to follow-up loss in early period of this study, and finally, 39 in the on-demand group and 41 in the continuous group were analyzed. No significant intergroup difference was found between Likert scale or frequency scale of heartburn or regurgitation at baseline. Percentages of symptom alleviations in the on-demand and continuous groups for intensity of heartburn were 56.4%/48.8% at baseline (P = .523) and 82.1%/87.8% at 12 weeks (P = .471), for frequency of heartburn were 61.5%/46.3% at baseline (P = .173) and 76.9%/87.8% at 12 weeks (P = .200), for intensity of regurgitation was 53.8%/43.9% at baseline (P = .374) and 82.1%/87.8% at 12 weeks (P = .471), and for frequency of regurgitation was 61.5%/56.1% at the baseline (P = .621) and 82.1%/82.9% at 12 weeks (P = .918), respectively. Furthermore, no significant intergroup difference was found for convenience of medication or subjective satisfaction.Conclusions:Intensities and frequencies of heartburn and regurgitation responded well to maintenance treatment in patients in the on-demand and continuous groups. On-demand therapy with esomeprazole 40 mg appears to be sufficient for maintenance treatment in GERD patients.

On-demand Versus Continuous Maintenance Treatment of Gastroesophageal Reflux Disease With Proton Pump Inhibitors: A Systematic Review and Meta-analysis

“…The study design was a randomized, open-label study except for 1 study by van der Velden et al, 24 which was a randomized, double-blind study. Two studies 16 , 20 were conducted in Asian countries, and all other studies were performed in Western countries. Three studies by Hansen et al, 17 Morgan et al, 19 and Szucs et al 22 included patients with GERD symptoms.…”

“…The detailed GERD definition in each study is described in Supplementary Table 1 . Except for 2 studies, 16 , 23 the PPI doses for on-demand and continuous maintenance treatment groups were the same. In the study by Cho et al, 16 40 mg esomeprazole was used in the on-demand group and 20 mg esomeprazole was used in the continuous group.…”

“…Except for 2 studies, 16 , 23 the PPI doses for on-demand and continuous maintenance treatment groups were the same. In the study by Cho et al, 16 40 mg esomeprazole was used in the on-demand group and 20 mg esomeprazole was used in the continuous group. In the study by Tsai et al, 23 20 mg esomeprazole was used in the on-demand group and 15 mg lansoprazole was used in the continuous group.…”

“…In the study by Tsai et al, 23 20 mg esomeprazole was used in the on-demand group and 15 mg lansoprazole was used in the continuous group. The duration of maintenance therapy in the 2 studies by Cho et al 16 and van der Velden et al 24 was 12 and 13 weeks, respectively, and the remaining studies were maintained for 6 months. The risk of bias graph and risk of bias summary of included studies are presented in Supplementary Figure 1 and Supplementary Figure 2 , respectively.…”

“…The characteristics of the 11 included studies are summarized in Supplementary Table 1. [14][15][16][17][18][19][20][21][22][23][24] The studies were RCTs published between 2004 and 2018, consisting of a total of 6138 GERD patients. The study design was a randomized, open-label study except for 1 study by van der Velden et al, 24 which was a randomized, double-blind study.…”