Poen A C, Otten M H
Meander Medisch Centrum, afd. Interne Geneeskunde en Gastroenterologie, Amersfoort.
Ned Tijdschr Geneeskd. 2003 Aug 23;147(34):1632-6.
Although proton pump inhibitors and H2-receptor antagonists are usually prescribed for continuous use by patients with gastro-oesophageal reflux disease, at least 50% of such patients do not take their medication daily and some take it only sporadically. On-demand treatment with proton pump inhibitors or H2-receptor antagonists is safe and cost-effective. Indications are: (a) incidental reflux episodes of short duration, (b) periodic reflux lasting several weeks or months, (c) chronic reflux not requiring continuous treatment. On-demand treatment is unsuitable for patients with reflux disease who either require daily medication or in whom the maximal dosage is insufficient. There are three types of on-demand treatment. Type 1: use of medication only in case of incidental symptoms. Type 2: continuous medication for 2-4 weeks when symptoms appear. Type 3: continuous use because of chronic symptoms, but the interval between doses is determined by the patient on the basis of his symptoms. All antacids can in principle be used for on-demand treatment; for type 3 treatment, antacids with a rapid onset of action are preferred. A favourable response to the two weeks of initial therapy is a good predictor for successful on-demand treatment.
尽管质子泵抑制剂和H2受体拮抗剂通常被开给胃食管反流病患者持续使用，但至少50%的此类患者并非每日服药，有些患者只是偶尔服药。使用质子泵抑制剂或H2受体拮抗剂进行按需治疗是安全且具有成本效益的。适用情况包括：（a）偶尔出现的短期反流发作；（b）持续数周或数月的周期性反流；（c）不需要持续治疗的慢性反流。按需治疗不适用于需要每日服药或最大剂量不足的反流病患者。按需治疗有三种类型。类型1：仅在出现偶然症状时使用药物。类型2：症状出现时持续用药2 - 4周。类型3：因慢性症状持续使用，但剂量间隔由患者根据自身症状确定。原则上所有抗酸剂都可用于按需治疗；对于类型3治疗，首选起效迅速的抗酸剂。对初始两周治疗的良好反应是按需治疗成功的良好预测指标。
