title: Systematic review: Is there excessive use of proton pump inhibitors in gastro-oesophageal reflux disease?
abstract: BACKGROUND
  Proton-pump inhibitors are often recommended for continuous use in gastro-oesophageal reflux disease, but this may not be necessary in all patients.
  
  
  OBJECTIVE
  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.
authors.affiliation: Division of Gastroenterology, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: T J
authors.initials: TJ
authors.lastname: Lee
authors.forename: M B
authors.initials: MB
authors.lastname: Fennerty
authors.forename: C W
authors.initials: CW
authors.lastname: Howden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D005764:Gastroesophageal Reflux / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D054328:Proton Pump Inhibitors; D016032:Randomized Controlled Trials as Topic
chemical_list: D054328:Proton Pump Inhibitors