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Systematic review: the efficacy of intermittent and on-demand therapy with histamine H2-receptor antagonists or proton pump inhibitors for gastro-oesophageal reflux disease patients
Article first published online: 2 JUN 2005
DOI: 10.1111/j.1365-2036.2005.02490.x
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How to Cite
Zacny, J., Zamakhshary, M., Sketris, I. and Veldhuyzen van Zanten, S. (2005), Systematic review: the efficacy of intermittent and on-demand therapy with histamine H2-receptor antagonists or proton pump inhibitors for gastro-oesophageal reflux disease patients. Alimentary Pharmacology & Therapeutics, 21: 1299–1312. doi: 10.1111/j.1365-2036.2005.02490.x
Publication History
- Issue published online: 2 JUN 2005
- Article first published online: 2 JUN 2005
- Accepted for publication 23 March 2005
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Summary
Aim : To perform a systematic review on the efficacy of intermittent and on-demand therapy with either histamine H2-receptor antagonists or proton pump inhibitors for patients with erosive oesophagitis or symptomatic heartburn.
Method : We conducted randomized-controlled trials of non-continuous therapy in gastro-oesophageal reflux disease patients.
Results : Fourteen studies met inclusion criteria. Because of variation in outcome measures statistical pooling of results was not possible. Results were analysed qualitatively. Four studies evaluated intermittent therapy of treatment 3 days a week with omeprazole 20 mg or daily with ranitidine which were not efficacious compared to a daily proton pump inhibitor. Famotidine 10 and 20 mg, ranitidine 75 mg and cimetidine 200 mg were efficacious in five on-demand studies for relief of symptomatic heartburn episodes. In three of four studies, evaluating only non-erosive (endoscopy-negative) gastro-oesophageal reflux disease patients, esomeprazole 20 and 40 mg and omeprazole 10 and 20 mg a day were efficacious using willingness to continue as an endpoint. Lansoprazole 30 mg and omeprazole 20 mg maintained symptom control in 60–70% of healed oesophagitis patients.
Conclusions : Intermittent proton pump inhibitor or H2-receptor antagonist therapy is not effective in maintaining control in oesophagitis patients. H2-receptor antagonists are effective for relief of heartburn episodes. On-demand proton pump inhibitor therapy may work in a proportion of non-erosive gastro-oesophageal reflux disease patients.