Daily treatment with esomeprazole is superior to that taken on-demand for maintenance of healed erosive oesophagitis.
BACKGROUND
On-demand therapy with esomeprazole is effective for long-term treatment of non-erosive gastro-oesophageal reflux disease, but it has not been evaluated in erosive gastro-oesophageal reflux disease.


OBJECTIVE
To compare endoscopic and symptomatic remission over a 6-month period when patients with healed erosive gastro-oesophageal reflux disease are treated with esomeprazole 20 mg, either once daily or on-demand.


METHODS
Patients with verified erosive reflux oesophagitis of Los Angeles grades A-D were enrolled. Following 4-8 weeks treatment with esomeprazole 40 mg daily, those who were endoscopically healed and had symptom control during the last week were randomized to maintenance therapy for 6 months with esomeprazole 20 mg, taken either once daily or on-demand.


RESULTS
Of 539 enrolled patients, 494 (91%) were healed at 8 weeks and 477 were randomized to maintenance therapy with esomeprazole 20 mg, 243 once daily and 234 on-demand. After once daily treatment, 81% of patients were still in remission at 6 months, compared with only 58% who took on-demand treatment (P < 0.0001). A difference in remission was found irrespective of baseline grade of oesophagitis, but it was more pronounced for the more severe grades. There was no difference in overall symptomatic remission between the two treatments, although heartburn was significantly more prevalent in the on-demand group.


CONCLUSIONS
Once daily esomeprazole 20 mg was better than that taken on-demand for maintaining healed erosive oesophagitis, regardless of baseline Los Angeles grade.
Sjöstedt
S
S
Department of Surgery, Nyköping Hospital, Nyköping, Sweden. svante.sjostedt@nln.dll.se
Befrits
R
R
Sylvan
A
A
Harthon
C
C
Jörgensen
L
L
Carling
L
L
Modin
S
S
Stubberöd
A
A
Toth
E
E
Lind
T
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000897:Anti-Ulcer Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004334:Drug Administration Schedule; D064098:Esomeprazole / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D004941:Esophagitis / Q000188:drug therapy / Q000517:prevention & control*; D004945:Esophagoscopy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012074:Remission Induction; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000897:Anti-Ulcer Agents; D064098:Esomeprazole