On-demand Versus Continuous Maintenance Treatment of Gastroesophageal Reflux Disease With Proton Pump Inhibitors: A Systematic Review and Meta-analysis
- 주제(키워드) Gastroesophageal reflux , Maintenance , Proton pump inhibitors
- 주제(기타) Gastroenterology & Hepatology
- 주제(기타) Clinical Neurology
- 설명문(일반) [Kang, Seung Joo] Seoul Natl Univ, Dept Internal Med, Hosp Gangnam Ctr, Seoul, South Korea; [Jung, Hye-Kyung; Tae, Chung Hyun] Ewha Womans Univ, Dept Internal Med, Coll Med, Seoul, South Korea; [Kim, Seung Young] Korea Univ, Coll Med, Dept Internal Med, Seoul, South Korea; [Lee, Kwang Jae] Ajou Univ, Dept Gastroenterol, Sch Med, 164 World Cup Ro, Suwon 16499, Gyeonggi Do, South Korea
- 등재 SCIE, SCOPUS, KCI등재
- OA유형 Green Published, gold
- 발행기관 KOREAN SOC NEUROGASTROENTEROLOGY & MOTILITY
- 발행년도 2022
- 총서유형 Journal
- URI http://www.dcollection.net/handler/ewha/000000190806
- 본문언어 영어
- Published As https://doi.org/10.5056/jnm21095
- PubMed https://pubmed.ncbi.nlm.nih.gov/34980685
초록/요약
Background/Aims Long-term maintenance treatment of gastroesophageal reflux disease (GERD) is commonly used to prevent relapse of reflux symptoms; however, due to concerns about safety of long-term proton pump inhibitors (PPI) use, on-demand therapy is recommended as a long-term treatment modality. We compared the efficacy of on-demand and continuous PPI therapy for maintenance treatment of patients with GERD using meta-analysis. Methods Core electronic databases were searched for randomized controlled trials comparing on-demand and continuous therapy in GERD patients. The primary outcome was treatment failure of maintenance therapy, and the secondary outcomes included symptomatic relief, patient satisfaction, and amount of PPI use. Results Overall, 11 studies were selected in the systematic review and meta-analysis. Compared with continuous PPI therapy, on-demand therapy showed similar outcomes for treatment failure (risk ratio, 1.26; 95% confidence interval [CI], 0.76-2.07), particularly in the non-erosive esophageal reflux disease and mild erosive reflux disease group (risk ratio, 1.48; 95% CI, 0.39-5.63). In studies including severe esophagitis patients, continuous PPI maintenance treatment was more effective (beta, 0.127 [95% CI, 0.066-0.188]; P < 0.001). Severity of esophagitis was associated with higher efficacies of continuous maintenance therapy. The amount of daily PPI use was about half in the on-demand group compared to the continuous group (risk difference -0.52; 95% CI, -0.62--0.42). Conclusions On-demand PPI therapy shows comparable efficacy to the continuous maintenance treatment in the non-erosive esophageal reflux disease and mild erosive reflux disease group, and can remarkably reduce the amount of PPI use. Therefore, on-demand therapy may be preferentially recommended in the maintenance treatment of GERD unaccompanied by severe esophagitis.
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