On-demand PPI requirements in patients with endoscopy-negative GERD.
OBJECTIVE
To evaluate the need for on-demand treatment with proton pump inhibitor in patients with endoscopy-negative GERD.


BACKGROUND
Studies indicate that on-demand therapy is suitable for patients without mucosal disease, but the need for PPI in a monotherapy situation is not known.


METHODS
Forty-one patients with heartburn and/or acid reflux of more than 3 months duration participated in the study. All were endoscopy-negative and had responded positive to a test with lansoprazole 60 mg x 1 for 7 days. Twenty-four hour pH monitoring was attempted in all, but failed in 4. Twenty-eight had pH <4 more than 4% of the time, 9 had less. During a 3-month period, the patients were allowed to take 1 capsule 30 mg lansoprazole on-demand, maximum 2 capsules a day. The remaining capsules were counted monthly.


RESULTS
In the 3-month period, the median mean daily consumption was 1.06 capsule (95% CI: 0072-1.09). No significant difference was found between those with normal or abnormal 24-hour pH-metry. Sixty-three percent used 6 or more capsules a week.


CONCLUSIONS
Patients with longstanding negative-endoscopy reflux disease, whether abnormal or normal 24-hour pH-metry, have symptoms that demand effective therapy. Using PPI on-demand as monotherapy, most patients will need 1 capsule per day.
Juul-Hansen
Paul
P
Department of Medicine, Akershus University Hospital, Nordbyhagen, Norway. paul.juul-hansen@klinmed.uio.no
Rydning
Andreas
A
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000328:Adult; D000368:Aged; D000897:Anti-Ulcer Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D002214:Capsules; D004334:Drug Administration Schedule; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications / Q000188:drug therapy*; D006356:Heartburn / Q000188:drug therapy / Q000209:etiology; D006801:Humans; D006863:Hydrogen-Ion Concentration / Q000187:drug effects; D064747:Lansoprazole; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009853:Omeprazole / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000627:therapeutic use*; D011446:Prospective Studies; D054328:Proton Pump Inhibitors; D016896:Treatment Outcome
D053799:2-Pyridinylmethylsulfinylbenzimidazoles; D000897:Anti-Ulcer Agents; D002214:Capsules; D054328:Proton Pump Inhibitors; D064747:Lansoprazole; D009853:Omeprazole