On-demand Versus Continuous Maintenance Treatment With a Proton Pump Inhibitor for Mild Gastroesophageal Reflux Disease: A Prospective Randomized Multicenter Study

Background/Aims It remains unclear which maintenance treatment modality is most appropriate for mild gastroesophageal reflux disease (GERD). We aimed to compare on-demand treatment with continuous treatment using a proton pump inhibitor (PPI) in the maintenance treatment for patients with non-erosiv...

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Published in:Journal of neurogastroenterology and motility 2023-10, Vol.29 (4), p.460
Main Authors: Da Hyun Jung, Young Hoon Youn, Hye-kyung Jung, Seung Young Kim, Cheal Wung Huh, Cheol Min Shin, Jung-hwan Oh, Kyu Chan Huh, Moo In Park, Suck Chei Choi, Ki Bae Kim, Seon-young Park, Joong Goo Kwon, Yu Kyung Cho, Jung Ho Park, Jeong Eun Shin, Eun Jeong Gong, Jae Hak Kim, Su Jin Hong, Hyun Jin Kim, Sam Ryong Jee, Ju Yup Lee, Kee Wook Jung, Hee Man Kim, Kwang Jae Lee
Format: Article
Language:Korean
Subjects:
Gastroesophageal reflux
Maintenance
Proton pump inhibitors
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Summary:Background/Aims It remains unclear which maintenance treatment modality is most appropriate for mild gastroesophageal reflux disease (GERD). We aimed to compare on-demand treatment with continuous treatment using a proton pump inhibitor (PPI) in the maintenance treatment for patients with non-erosive GERD or mild erosive esophagitis. Methods Patients whose GERD symptoms improved after 4 weeks of standard dose PPI treatment were prospectively enrolled at 25 hospitals. Subsequently, the enrolled patients were randomly assigned to either an on-demand or a continuous maintenance treatment group, and followed in an 8-week interval for up to 24 weeks. Results A total of 304 patients were randomized to maintenance treatment (continuous, n = 151 vs on-demand, n = 153). The primary outcome, the overall proportion of unwillingness to continue the assigned maintenance treatment modality, failed to confirm the noninferiority of on-demand treatment (45.9%) compared to continuous treatment (36.1%). Compared with the on-demand group, the GERD symptom and health-related quality of life scores significantly more improved and the overall satisfaction score was significantly higher in the continuous treatment group, particularly at week 8 and week 16 of maintenance treatment. Work impairment scores were not different in the 2 groups, but the prescription cost was less in the on-demand group. Serum gastrin levels significantly elevated in the continuous treatment group, but not in the on-demand group. Conclusions Continuous treatment seems to be more appropriate for the initial maintenance treatment of non-erosive GERD or mild erosive esophagitis than on-demand treatment. Stepping down to on-demand treatment needs to be considered after a sufficient period of continuous treatment. (J Neurogastroenterol Motil 2023;29:460-469)
ISSN:2093-0879
2093-0887