PubMed · 13260432
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S VOLO. 1955. [Antacids].. https://pubmed.ncbi.nlm.nih.gov/13260432/
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Gastric acid inhibitors are effective and safe drugs for the treatment of gastro-oesophageal reflux disease. Since reflux disease is frequent in Western populations, the use of gastric acid inhibitors leads to a considerable financial burden to the community. However, a large proportion of the patients with reflux symptoms do not take their medication continuously but use the drugs as required by their symptoms. This opens the possibility of a more cost-effective approach in which optimal symptom relief is achieved in combination with cost reduction. The type of on-demand therapy must be based on the individual pattern of reflux symptoms. In this approach, the patient determines the actual therapy whereas the physician functions as advisor. It is presently unknown whether any adverse effects result from the long-term on-demand therapy of reflux disease.
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.
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