Systematic review: is there excessive use of proton pump inhibitors in gastro-oesophageal reflux disease?
| Autor: | Colin W. Howden, T. J. Lee, M. B. Fennerty |
|---|---|
| Rok vydání: | 2004 |
| Předmět: |
medicine.medical_specialty
Hepatology business.industry medicine.drug_class Esophageal disease digestive oral and skin physiology Gastroenterology Reflux Proton-pump inhibitor Disease Evidence-based medicine medicine.disease digestive system diseases Gastro Continuous use Internal medicine medicine Pharmacology (medical) Observational study business |
| Zdroj: | Alimentary Pharmacology & Therapeutics. 20:1241-1251 |
| ISSN: | 0269-2813 |
| DOI: | 10.1111/j.1365-2036.2004.02289.x |
| Popis: | 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 H2-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. |
| Databáze: | OpenAIRE |
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