Digestive Diseases

Esophagus

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On-Demand Therapy Is a Valid Strategy in GERD Patients: Pros and Cons

Leodolter A.a · Penagini R.b

Author affiliations

aMedical Department, Ev.-Jung-Stilling Hospital, Academic Hospital of the University of Bonn, Siegen, Germany; bCattedra di Gastroenterologia, Dipartimento di Scienze Mediche, University of Milan, and Fondazione IRCCS Ospedale Maggiore, Mangiagalli, Regina Elena, Milan, Italy

Corresponding Author

Prof. R. Penagini

Fondazione IRCCS Ospedale Maggiore Policlinico

Mangiagalli e Regina Elena, Pad Granelli

Via F. Sforza 35, IT–20122 Milano (Italy)

Tel. +39 02 5503 3311, Fax +39 02 5503 3644, E-Mail roberto.penagini@unimi.it

Keywords: On-demand GERD treatmentGastroesophageal reflux diseaseOn-demand GERD therapy, pros and consProton pump inhibitors

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Dig Dis 2007;25:175–178
https://doi.org/10.1159/000103880

Abstract

On-demand proton pump inhibitor (PPI) therapy is an attractive option for long-term management of gastroesophageal reflux disease (GERD). Controlled trials in non-erosive reflux disease (NERD) patients have shown sufficient symptom control in most patients with a high rate of willingness to continue treatment and substantial saving on PPI expenditure. However, due to the slow onset of action of PPIs, rescue antacids are often used when symptoms recur and several patients continue to experience some degree of heartburn. On-demand treatment is less cost-saving in patients with esophagitis, and symptomatic/endoscopic relapses occur frequently in severe grades. Data on the prevention of long-term sequelae of on-demand treatment are scarce, only indirect evidence being available. It is suggested that PPI continuous maintenance is more appropriate than on-demand therapy in patients with severe esophagitis, in those with Barrett’s esophagus where chronic PPIs may reduce incidence of dysplasia, in uninvestigated elderly patients where esophagitis is more prevalent and it is more frequently complicated with gastrointestinal bleeding and possibly in uninvestigated or NERD patients with frequent clinical relapses. Finally, more appropriate outcome variables should be used in future trials in order to assess efficacy of on-demand treatment adequately.

© 2007 S. Karger AG, Basel



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Article / Publication Details

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Abstract of Esophagus

Published online: September 10, 2007
Issue release date: September 2007

Number of Print Pages: 4
Number of Figures: 0
Number of Tables: 0

ISSN: 0257-2753 (Print)
eISSN: 1421-9875 (Online)

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2007, Vol.25, No. 3

September 2007

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