On-demand Versus Continuous Maintenance Treatment With a Proton Pump Inhibitor for Mild Gastroesophageal Reflux Disease: A Prospective Randomized Multicenter Study
- Authors
- 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, Moo In; 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
- Issue Date
- Oct-2023
- Publisher
- 대한소화기 기능성질환∙운동학회
- Keywords
- Gastroesophageal reflux; Maintenance; Proton pump inhibitors
- Citation
- Journal of Neurogastroenterology and Motility (JNM), v.29, no.4, pp 460 - 469
- Pages
- 10
- Indexed
- SCIE
SCOPUS
KCI
- Journal Title
- Journal of Neurogastroenterology and Motility (JNM)
- Volume
- 29
- Number
- 4
- Start Page
- 460
- End Page
- 469
- URI
- https://scholarworks.korea.ac.kr/kumedicine/handle/2021.sw.kumedicine/64376
- DOI
- 10.5056/jnm23130
- ISSN
- 2093-0879
2093-0887
- 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 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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Collections - 2. Clinical Science > Department of Gastroenterology and Hepatology > 1. Journal Articles
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