A systematic review including 16 studies with a total of at least 13374 subjects was abstracted in DARE. Most studies assessed discontinuation rates of proton pump inhibitors. One RCT (100 patients with grade A or B endoscopically diagnosed erosive esophagitis (EE) entered; 66 patients whose symptoms resolved with initial treatment took on-demand treatment) reported similar levels of symptom control at 4 to 8 weeks between patients taking on-demand esomeprazole 40 mg or omeprazole 20 mg and those taking continual daily dosing. On-demand treatment with omeprazole 20 mg was superior to continuous treatment in controlling GERD symptoms. One RCT (1,471 patients with GERD) reported similar levels of patient satisfaction for on-demand esomeprazole 20 mg and intermittent esomeprazole 40 mg daily for 2 to 4 weeks. One RCT (704 patients with EE or endoscopy-negative reflux disease) reported that one year of intermittent treatment (2- to 4-week courses) was successfully completed in 48% allocated to omeprazole 20 mg, 46% allocated to omeprazole 10 mg and 47% allocated to ranitidine. Patients experienced between 273 and 279 days in 12 months off treatment with PPI or H2-receptor antagonist.
Comment: The quality of evidece is downgraded by several limitations in review methodology.