On-demand therapy for gastro-oesophageal reflux disease.

A chronic and recurrent disorder gastro-oesophageal reflux disease (GORD) affects as many as 50% of adults and is likely to require long-term therapy. Proton pump inhibitors (PPIs) are now considered first-line treatment for GORD, with daily dosing the currently accepted approach to long-term treatment. However, most patients with GORD treat themselves on an as-needed basis to relieve symptoms (primarily heartburn) associated with this disease. Limited results from clinical trials and pharmacoeconomic studies have shown that 'on-demand' therapy is both efficacious and cost-effective in patients with uncomplicated GORD. Newer PPIs, which rapidly and profoundly suppress acid secretion and provide significant symptom relief with the first dose, may be most suitable for on-demand therapy in patients with uncomplicated GORD. First-dose acid suppression and symptom relief vary among PPIs; these differences require further investigation.