Evidence map›Paper›PMID 30158966›Full record

ReviewGastroenterology research and practice2018

On-Demand Therapy with Proton Pump Inhibitors for Maintenance Treatment of Nonerosive Reflux Disease or Mild Erosive Esophagitis: A Systematic Review and Meta-Analysis.

Zubair Khan, Yaseen Alastal, Muhammad Ali Khan, Mohammad Saud Khan, Basmah Khalil, Shreesh Shrestha, Faisal Kamal, Ali Nawras, Colin W Howden

Open access · goldAbstract readReview
PubMed Full text at PMC Publisher
In one paragraph

Review in Gastroenterology research and practice, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
18citing papers in PubMed, 2 pooled it
1.5field-weighted citation impact, top 18% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 45 citations in OpenAlex.

  1. Guidelines on optimizing the use of proton pump inhibitors: PPI stewardship.Indian journal of gastroenterology : official journal of the Indian Society of Gastroenterology · 2023
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

9 authors at 2 institutions in 1 country.

Zubair KhanDivision of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA.ORCID 0000-0001-5732-7678
Yaseen AlastalDivision of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA.
Muhammad Ali KhanDivision of Gastroenterology and Hepatology, The University of Tennessee Health Science Center, Memphis, TN, USA.ORCID 0000-0002-8583-843X
Mohammad Saud KhanDivision of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA.ORCID 0000-0001-5055-3226
Basmah KhalilDivision of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA.
Shreesh ShresthaDivision of Gastroenterology and Hepatology, The University of Tennessee Health Science Center, Memphis, TN, USA.
Faisal KamalDivision of Gastroenterology and Hepatology, The University of Tennessee Health Science Center, Memphis, TN, USA.
Ali NawrasDivision of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA.
Colin W HowdenDivision of Gastroenterology and Hepatology, The University of Tennessee Health Science Center, Memphis, TN, USA.
University of Toledo Medical Center · USUniversity of Tennessee Health Science Center · US

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundProton pump inhibitors (PPIs) are widely used for the long-term management of gastroesophageal reflux disease (GERD). However, concerns about the cost and/or inconvenience of continuous maintenance PPI treatment have led to the evaluation of various alternative approaches.

aimTo assess the effectiveness of on-demand PPI therapy in the maintenance treatment of nonerosive reflux disease (NERD) or mild erosive esophagitis (EE).

methodsWe searched MEDLINE, EMBASE, Web of Science, and Cochrane Library from inception until October 2, 2017, for randomized controlled trials (RCTs) comparing on-demand PPI versus placebo or daily PPI in the management of NERD or mild EE (Savary-Miller grade 1). Discontinuation of therapy during the trial was used as a surrogate for patient dissatisfaction and failure of symptomatic control. We calculated pooled odds ratios (OR) to evaluate the efficacy of on-demand PPI treatment. Separate analyses were conducted for studies comparing on-demand PPI with daily PPI and with placebo. Subgroup analysis was done based on NERD studies alone and on studies of both NERD and mild EE. These were analyzed using a random effects model.

resultsWe included 10 RCTs with 4574 patients. On-demand PPI was superior to daily PPI (pooled OR = 0.50; 95% confidence interval (CI) = 0.35, 0.72). On subgroup analysis in NERD patients only, pooled OR was 0.44 (0.29, 0.66). In studies including patients with NERD and mild EE, pooled OR was 0.76 (0.36, 1.60). For studies comparing on-demand PPI with placebo, pooled OR was 0.21 (0.15, 0.29); subgroup analyses of studies evaluating NERD only and studies conducted in NERD and mild EE showed similar results (pooled OR was 0.22 (0.13, 0.36) and 0.18 (0.11, 0.31), resp.).

conclusionsOn-demand PPI treatment is effective for many patients with NERD or mild EE. Although not FDA-approved, it may be adequate for those patients whose symptoms are controlled to their satisfaction.

Identifiers

PMID30158966
PMCPMC6109549
OpenAlexW2885639552

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.