On-demand Versus Continuous Maintenance Treatment With a Proton Pump Inhibitor for Mild Gastroesophageal Reflux Disease: A Prospective Randomized Multicenter Study
- Author:
Da Hyun JUNG
1
;
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
Author Information
- Publication Type:Original Article
- From:Journal of Neurogastroenterology and Motility 2023;29(4):460-469
- CountryRepublic of Korea
- Language:English
-
Abstract:
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.
