On-Demand Therapy with Proton Pump Inhibitors for Maintenance Treatment of Nonerosive Reflux Disease or Mild Erosive Esophagitis: A Systematic Review and Meta-Analysis

Table 1

Characteristics of studies comparing on-demand PPI with daily PPI.

References	Country	Center; (multi, single)	Study design	Inclusion criteria	Exclusion criteria	PPI regimen for continuous therapy	PPI regimen for on-demand therapy	Outcome studied	Follow-up period	Esophagitis class
[19]	UK (92 general practices, 28 hospitals)	Multicenter	Single-blind (investigator), randomized, parallel group study	NERD with resolution of heartburn after 2 to 4 weeks of esomeprazole 20	Patients with persistent heartburn and structural diseases	Lansoprazole 15 mg PO once daily	Esomeprazole 20 mg	Time to discontinuation due to unwillingness to continue	6 months	Not applicable
[20]	Single university hospital Japan	Single center	Prospective parallel randomized open-label study	Patients with modified LA class M after having 8-week treatment with PPIs	Patients with cancer, serious liver disease, kidney disease, heart disease, a hematological disorder, gastric ulcers, and/or duodenal ulcers	Omeprazole 20 mg	Omeprazole 20 mg	Symptom relief at 4, 8, 16, and 24 weeks in each study group with relief from symptoms as the primary endpoint	6 months	Modified LA class M
[21]	Austria, France, Germany, South Africa, and Spain (61 centers)	Multicenter	Open-label, randomized, parallel group	NERD who were heartburn-free after 4-week treatment with esomeprazole 20 mg daily	Reflux esophagitis	Esomeprazole 20 mg	Esomeprazole 20 mg	Discontinuation due to unsatisfactory treatment	6 months	Not applicable
[22]	58 active centers: 29 in Germany, 12 in France, 11 in Switzerland, and 6 in Hungary	Multicenter	Open-label, randomized, parallel group	NERD + mild esophagitis treated with pantoprazole 20 mg PO daily for 4 weeks	Patients with persistent symptoms and heartburn, erosive esophagitis	Pantoprazole 20 mg	Pantoprazole 20 mg	The symptoms (as assessed in the patient’s diary) were considered controlled until the time of failure, which was defined as the first point at which one of the following events occurred: (1) GERD symptoms of at least moderate severity were present for 3 or more consecutive days despite medication (event time = the first of these 3 days); (2) use of >1 tablet of study medication on >3 consecutive days (event time = the first of these 3 days); or (3) premature withdrawal from the study due to lack of efficacy (event time = the date of withdrawal)	6 months	Savary-Miller grade 0 or 1