Maintenance Treatment of Mild Gastroesophageal Reflux Disease with Proton Pump Inhibitors Taken On-Demand: A Meta-Analysis

Background/Aims: To evaluate the efficacy of on-demand strategy with proton pump inhibitors (PPIs) in mild gastroesophageal reflux disease (GERD). Methodology: A literature search was conducted to identify randomized controlled clinical trials which investigating on-demand treatment with PPIs in mild GERD. The control group should be placebo or once-daily treatment. Comparison of treatment effect was performed. Results: Eight studies met the inclusion criteria, of which six were compared with placebo, two others with once-daily treatment. The percentage of patients unwilling to continue the study was 12.1% in the on-demand group while 39.6% in the placebo group. The meta-analysis revealed a statistically significant difference between the two groups (RR: 0.32; 95% CI: 0.23, 0.43). We obtained a similar result when compared with once-daily treatment (RR: 0.52; 95% CI: 0.34, 0.79). Conclusions: This meta-analysis indicates that on-demand therapy with PPIs is superior to placebo or once-daily treatment in terms of mild GERD.