Comparison of continuous versus on-demand proton pump inhibitor therapy in symptom control of patients with Barrett's esophagus.

Background: Whether continuous proton pump inhibitor (PPI) therapy is superior to on-demand therapy for symptom control of Barrett's esophagus patients is unclear. The study aimed to compare the efficacies of the symptom control and the frequency of co-existent erosive esophagitis in patients with Barrett's esophagus by either continuous or on-demand PPI therapy.

Methods: We randomly assigned (1:1) consecutive adult patients with symptomatic Barrett's esophagus to receive on-demand or continuous esomeprazole (40 mg q.d.) therapy for 40 weeks following an initial treatment with esomeprazole 40 mg daily for 8 weeks. A follow-up endoscopy was conducted at week 48. The primary outcome was total number of symptomatic days. The secondary outcome was the frequency of co-existent erosive esophagitis at week 48.

Results: From February 2010 to December 2022, we randomly assigned 235 eligible patients to receive either on-demand (n = 119) or continuous (n = 116) esomeprazole therapy. The on-demand and continuous groups did not signicantly differ in symptom scores at each follow-up time point. Two treatment groups had a comparable total number of symptom days (27.7 ± 41.5 vs 24.3 ± 47.7; P = 0.570) but the on-demand group took fewer esomeprazole tablets than the continuous group (230.6 ± 96.5 vs 330.0 ± 15.6; P < 0.001). At week 48, the on-demand and continuous groups had comparable frequencies of erosive esophagitis (10.6% vs 6.7%).

Conclusion: On-demand PPI therapy reduces the total amount of PPI used while achieving similar symptom relief compared to continuous PPI therapy in patients with Barrett's esophagus.