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KMID : 1812020230290040460
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Journal of Neurogastroenterology and Motility
2023 Volume.29 No. 4 p.460 ~ p.469
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On-demand Versus Continuous Maintenance Treatment With a Proton Pump Inhibitor for Mild Gastroesophageal Reflux Disease: A Prospective Randomized Multicenter Study
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Jung Da-Hyun
Youn Young-Hoon
Jung Hye-Kyung
Kim Seung-Young
Huh Cheal-Wung
Shin Cheol-Min
Oh Jung-Hwan
Huh Kyu-Chan
Park Kyung-Hoon
Choi Suck-Chei
Kim Ki-Bae
Park Seon-Young
Kwon Joong-Goo
Cho Yu-Kyung
Park Jung-Ho
Shin Jeong-Eun
Gong Eun-Jeong
Kim Jae-Hak
Hong Su-Jin
Kim Hyun-Jin
Jee Sam-Ryong
Lee Ju-Yup
Jung Kee-Wook
Kim Hee-Man
Lee Kwang-Jae
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Abstract
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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 non-inferiority 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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KEYWORD
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Gastroesophageal reflux, Maintenance, Proton pump inhibitors
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