Systematic review: the efficacy of intermittent and on-demand therapy with histamine H2-receptor antagonists or proton pump inhibitors for gastro-oesophageal reflux disease patients

Aliment Pharmacol Ther. 2005 Jun 1;21(11):1299-312. doi: 10.1111/j.1365-2036.2005.02490.x.


Aim: To perform a systematic review on the efficacy of intermittent and on-demand therapy with either histamine H2-receptor antagonists or proton pump inhibitors for patients with erosive oesophagitis or symptomatic heartburn.

Method: We conducted randomized-controlled trials of non-continuous therapy in gastro-oesophageal reflux disease patients.

Results: Fourteen studies met inclusion criteria. Because of variation in outcome measures statistical pooling of results was not possible. Results were analysed qualitatively. Four studies evaluated intermittent therapy of treatment 3 days a week with omeprazole 20 mg or daily with ranitidine which were not efficacious compared to a daily proton pump inhibitor. Famotidine 10 and 20 mg, ranitidine 75 mg and cimetidine 200 mg were efficacious in five on-demand studies for relief of symptomatic heartburn episodes. In three of four studies, evaluating only non-erosive (endoscopy-negative) gastro-oesophageal reflux disease patients, esomeprazole 20 and 40 mg and omeprazole 10 and 20 mg a day were efficacious using willingness to continue as an endpoint. Lansoprazole 30 mg and omeprazole 20 mg maintained symptom control in 60-70% of healed oesophagitis patients.

Conclusions: Intermittent proton pump inhibitor or H2-receptor antagonist therapy is not effective in maintaining control in oesophagitis patients. H2-receptor antagonists are effective for relief of heartburn episodes. On-demand proton pump inhibitor therapy may work in a proportion of non-erosive gastro-oesophageal reflux disease patients.

Publication types

  • Review
  • Systematic Review

MeSH terms

  • Drug Administration Schedule
  • Gastroesophageal Reflux / drug therapy*
  • Histamine H2 Antagonists / administration & dosage*
  • Humans
  • Proton Pump Inhibitors*
  • Randomized Controlled Trials as Topic
  • Treatment Outcome


  • Histamine H2 Antagonists
  • Proton Pump Inhibitors