Proton-pump inhibitors (PPIs) are used for the long-term management of gastroesophageal reflux disease (GERD). Originally approved for the treatment of erosive esophagitis, they also are commonly used to treat patients with nonerosive reflux disease. In a recent issue of Alimentary Pharmacology and Therapeutics, Thomas J. Lee, MD, and colleagues addressed the potential overuse of these agents. Their review of the literature included observational studies and randomized controlled trials that assessed the ability of patients'symptoms to be adequately controlled by less aggressive PPI treatment.
A significant number of patients had adequate symptom control when the daily PPI regimen was reduced in dosage (eg, 40 mg reduced to 20 mg) or when the dosage regimen was changed from daily to intermittent (every other day) or on-demand treatment. Studies indicated that, once symptoms were controlled, PPI therapy could be substituted with histamine H2A receptor antagonist therapy while maintaining a high degree of patient-reported satisfaction with efficacy. Physicians should consider the cost benefit and evaluate which of their GERD patients could be managed on reduced PPI therapy.