Premium
Systematic review: is there excessive use of proton pump inhibitors in gastro‐oesophageal reflux disease?
Author(s) -
Lee T. J.,
Fennerty M. B.,
Howden C. W.
Publication year - 2004
Publication title -
alimentary pharmacology and therapeutics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.308
H-Index - 177
eISSN - 1365-2036
pISSN - 0269-2813
DOI - 10.1111/j.1365-2036.2004.02289.x
Subject(s) - medicine , proton pump inhibitor , reflux , gastroenterology , proton pump , placebo , rabeprazole , esophageal disease , disease , gastro , randomized controlled trial , esophagus , pathology , biochemistry , chemistry , alternative medicine , atpase , enzyme
Summary Background : Proton‐pump inhibitors are often recommended for continuous use in gastro‐oesophageal reflux disease, but this may not be necessary in all patients. Aim : To ascertain the level of evidence for alternative strategies for proton‐pump inhibitor treatment in gastro‐oesophageal reflux disease. Methods : We searched for observational or interventional studies examining alternatives to continuous proton‐pump inhibitor treatment in gastro‐oesophageal reflux disease. Results : Non‐randomized studies suggest that some patients with gastro‐oesophageal reflux disease, including some with erosive oesophagitis, may be adequately maintained on proton‐pump inhibitor therapy given less frequently than once daily. However, the results may not be generalizable. Four high quality randomized‐controlled trials compared ‘on‐demand’ proton‐pump inhibitor and placebo treatment in endoscopy‐negative reflux disease; all found this effective for most patients. One high quality randomized‐controlled trial found intermittent courses of a proton‐pump inhibitor or H 2 ‐receptor antagonist in erosive oesophagitis or endoscopy‐negative reflux disease adequate for almost half of the patients studied. Up to 80% of patients on continuous high‐dose proton‐pump inhibitor treatment for gastro‐oesophageal reflux disease can be ‘stepped down’ to less intensive therapy. Conclusions : On‐demand proton‐pump inhibitor treatment may be appropriate in endoscopy‐negative reflux disease. In gastro‐oesophageal reflux disease, patients taking more than once daily or high‐dose proton‐pump inhibitor treatment, a step down to once daily or standard dose therapy should be attempted.