J Neurogastroenterol Motil.
2023 Oct;29(4):460-469. 10.5056/jnm23130.
On-demand Versus Continuous Maintenance Treatment With a Proton Pump Inhibitor for Mild Gastroesophageal Reflux Disease: A Prospective Randomized Multicenter Study
- Affiliations
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- 1Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 2Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 3Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea
- 4Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
- 5Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- 6Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi-do, Korea
- 7Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
- 8Division of Gastroenterology, Department of Internal Medicine, College of Medicine, Konyang University, Daejeon, Korea
- 9Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
- 10Department of Gastroenterology, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Korea
- 11Department of Internal Medicine, Chungbuk National University School of Medicine, Cheongju, Chungcheongbuk-do, Korea
- 12Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
- 13Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
- 14Catholic Photomedicine Research Institute, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Kore
- 15Department of Internal Medicine, Kangbuk Samsung Hospital, Sungkyunkwan University College of Medicine, Seoul, Korea
- 16Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea
- 17Department of Internal Medicine, College of Medicine, Hallym University, Chuncheon, Gangwon-do, Korea
- 18Department of Internal Medicine, Dongguk University College of Medicine, Goyang, Gyeonggi-do, Korea
- 19Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Gyeonggi-do, Korea
- 20Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Gyeongsangnam-do, Korea
- 21Department of Internal Medicine, Inje University Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
- 22Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea
- 23Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- 24Health Promotion, Gangnam Severance Hospital, Seoul, Korea
- 25Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea
- KMID: 2546970
- DOI: http://doi.org/10.5056/jnm23130
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.
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