On-Demand PPI Use Examined in Non-Erosive Reflux Disease, Mild Erosive Esophagitis

A total of 10 RCTs with 4574 patients were included in the review
A total of 10 RCTs with 4574 patients were included in the review

Utilizing proton pump inhibitors (PPIs) “on-demand” is an effective treatment option for patients suffering from non-erosive reflux disease (NERD) or mild erosive esophagitis (EE), according to results of a recently published review in Gastroenterology Research and Practice.

The systematic review and meta-analysis aimed to determine the efficacy of PPIs when used on-demand for the treatment of NERD or EE. MEDLINE, EMBASE, Web of Science, and the Cochrane Library were utilized to search for randomized controlled trials (RCTs) comparing on-demand PPI therapy to placebo or daily PPI administration for the treatment of NERD or mild EE.  

“Discontinuation of therapy during the trial was used as a surrogate for patient dissatisfaction and failure of symptomatic control,” the study authors explained. Adding, "We calculated pooled odds ratios (OR) to evaluate the efficacy of on-demand PPI treatment. Separate analyses were conducted for studies comparing on-demand PPI with daily PPI and with placebo." 

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A total of 10 RCTs with 4574 patients were included in the review. Results of the study found on-demand PPI use to be superior to daily administration of a PPI (pooled OR: 0.50; 95% CI: 0.35, 0.72). Subgroup analysis yielded a pooled OR of 0.76 (95% CI: 0.36, 1.60) for studies including patients with both NERD and mild EE and 0.44 (95% CI: 0.29, 0.66) for studies including NERD patients only.

Additionally, a pooled OR of 0.21 (95% CI: 0.15, 0.29) was calculated when assessing on-demand PPI treatment compared to placebo. The study authors added, “subgroup analyses of studies evaluating NERD only and studies conducted in NERD and mild EE showed similar results (pooled OR was 0.22 (0.13, 0.36) and 0.18 (0.11, 0.31), resp.).“

Results of this review demonstrated the effectiveness of on-demand PPI therapy in the treatment of NERD or mild EE.

Reference:

Khan Z, Alastel Y, Ali Khan M, Saud Khan M, Khalil B, Shrestha S, Kamal F, Nawras A, Howden C. On-Demand Therapy with Proton Pump Inhibitors for Maintenance Treatment of Nonerosive Reflux Disease or Mild Erosive Esophagitis: A Systematic Review and Meta-Analysis. Gastroenterology Research and Practice, 2018. DOI.org/10.1155/2018/6417526.