On-demand therapy for gastroesophageal reflux disease

Am J Gastroenterol. 2007 Mar;102(3):642-53. doi: 10.1111/j.1572-0241.2006.00998.x.


The following pages summarize the proceedings of a symposium held in May 2006 on the emerging role of on-demand therapy for gastroesophageal reflux disease (GERD). Medical therapy for GERD has undergone significant change in recent years with the advent of effective, but expensive, antisecretory agents. On-demand (patient-driven) therapy is attractive to payers and patients, because it appears to be both cost-effective and convenient. Many individuals appear to accept occasional symptomatic breakthrough in exchange for personal control of their disease. On-demand therapy should be distinguished from intermittent therapy, which is either patient- or physician-driven, but which requires intermittent episodes of continuous therapy followed by discontinuation until symptoms recur. Proton pump inhibitors appear to be effective on-demand agents despite theoretical pharmacodynamic limitations for this class of drug. The available data support the use of on-demand therapy for GERD in uninvestigated reflux disease, nonerosive reflux disease, and possibly mild esophagitis as well. On-demand therapy should not be considered for patients with severe esophagitis.

Publication types

  • Review

MeSH terms

  • Congresses as Topic
  • Enzyme Inhibitors / therapeutic use*
  • Gastroesophageal Reflux / drug therapy*
  • Humans
  • Proton Pump Inhibitors*
  • Treatment Outcome


  • Enzyme Inhibitors
  • Proton Pump Inhibitors