Pace F, Tonini M, Pallotta S, Molteni P, Porro G B
Division of Gastroenterology, L. Sacco University Hospital, University of Milan, Italy.
Aliment Pharmacol Ther. 2007 Jul 15;26(2):195-204. doi: 10.1111/j.1365-2036.2007.03381.x.
Proton pump inhibitors (PPI) therapy 'on-demand' is often used as an alternative to continuous maintenance therapy in gastro-oesophageal reflux disease (GERD).
We conducted a systematic review with the specific objectives to ascertain whether on-demand PPI therapy was effective in preventing symptomatic relapse and to assess the relative efficacy of on-demand vs. continuous PPI maintenance strategy.
Randomized-controlled clinical trials comparing on-demand PPI vs. placebo or on-demand vs. continuous PPI therapy in GERD patients were identified by searching the Medline database and the Cochrane Controlled Trials Register.
Seventeen studies were found which met inclusion criteria. Out of the 17 studies: five investigated exclusively patients with non-erosive reflux disease (NERD), four patients with NERD and mild oesophagitis, two patients with erosive oesophagitis only, and two patients with uninvestigated GERD symptoms, respectively. Four further studies were not investigating the effectiveness of the therapies but primarily pharmacoeconomic or quality of life parameters.
On the basis of the analysis of 17 studies, we can conclude that on-demand therapy with currently available PPI appears to be effective in the long-term management of patients with NERD or mild and uninvestigated forms of GERD, but not in patients with (severe) erosive oesophagitis.
质子泵抑制剂（PPI）按需治疗常被用作胃食管反流病（GERD）持续维持治疗的替代方案。
我们进行了一项系统评价，具体目的是确定按需PPI治疗在预防症状复发方面是否有效，并评估按需与持续PPI维持策略的相对疗效。
通过检索Medline数据库和Cochrane对照试验注册库，识别比较GERD患者按需PPI与安慰剂或按需与持续PPI治疗的随机对照临床试验。
发现17项研究符合纳入标准。在这17项研究中：5项专门研究了非糜烂性反流病（NERD）患者，4项研究了NERD和轻度食管炎患者，2项仅研究了糜烂性食管炎患者，2项分别研究了未明确的GERD症状患者。另外4项研究未调查治疗的有效性，而是主要研究药物经济学或生活质量参数。
基于对17项研究的分析，可以得出结论，目前可用的PPI按需治疗似乎对NERD或轻度及未明确类型的GERD患者的长期管理有效，但对（重度）糜烂性食管炎患者无效。
