In order to prevent relapse of reflux symptoms, long-term maintenance treatment is often resorted to in gastroesophageal reflux disease (GERD). However, there are some concerns regarding the safety of long-term use of proton pump inhibitors (PPI). Therefore, on-demand therapy is recommended over the long-term.

A recent systematic review and meta-analysis compared the efficacy of on-demand and continuous PPI therapy for maintenance treatment in GERD patients.

Investigators searched the core electronic databases for randomized controlled trials that compared on-demand and continuous PPI therapy in GERD patients. The primary outcome was treatment failure of maintenance therapy, and the secondary outcomes were symptomatic relief, patient satisfaction, and amount of PPI use. Eleven studies were selected in the analysis.

• In comparison with continuous PPI therapy, on-demand therapy was found to have similar outcomes in terms of treatment failure (risk ratio, 1.26), especially in non-erosive esophageal reflux disease and mild erosive reflux disease (risk ratio, 1.48).
• In studies that involved patients with severe esophagitis, continuous PPI maintenance therapy was found to be more effective (β, 0.127 [95% CI, 0.066-0.188]; P < 0.001).
• There was a link between severity of esophagitis and higher efficacies of continuous maintenance therapy.
• Daily PPI use was nearly half in the on-demand treatment group compared to the continuous therapy group (risk difference -0.52; 95% CI, -0.62--0.42).

It was concluded that on-demand PPI therapy is comparable in efficacy to continuous maintenance treatment in non-erosive esophageal reflux disease and mild erosive reflux disease group, and is associated with decreased PPI use.

On-demand therapy may be preferred in the maintenance treatment of GERD that is not associated with severe esophagitis.

Source: Kang SJ, Jung HK, Tae CH, et al. On-demand Versus Continuous Maintenance Treatment of Gastroesophageal Reflux Disease With Proton Pump Inhibitors: A Systematic Review and Meta-analysis. J Neurogastroenterol Motil. 2022 Jan 30;28(1):5-14.