UEGW: Daily Maintenance Esomeprazole Provides Better Quality of Life Than On-Demand Treatment in Gastroesophageal Reflux Disease

A large Dutch trial suggests that if patients with gastroesophageal reflux disease (GERD) take esomeprazole 20 mg every day in the maintenance phase of treatment, they may have a better quality of life than patients who take 40 mg on-demand. In the maintenance treatment of GORD, the continued relief of symptoms, good erosion healing, patient satisfaction and quality of life are all important goals. Daily and on-demand therapy with 20 mg or 40 mg esomeprazole respectively are treatment options, but until now, little information has been available on which might provide the best quality of life.

By Adrian BurtonMADRID, SPAIN — November 14, 2003 — A large Dutch trial suggests that if patients with gastroesophageal reflux disease (GERD) take esomeprazole 20 mg every day in the maintenance phase of treatment, they may have a better quality of life than patients who take 40 mg on-demand.In the maintenance treatment of GORD, the continued relief of symptoms, good erosion healing, patient satisfaction and quality of life are all important goals. Daily and on-demand therapy with 20 mg or 40 mg esomeprazole respectively are treatment options, but until now, little information has been available on which might provide the best quality of life.”We took reflux patients of two categories, those with non-erosive disease [NED] and those with grade A or B [Los Angeles scale] reflux oesophagitis [RO] with significant symptoms of reflux. These were first made symptom free with esomeprazole 40 mg per day. After this acute phase they went into a maintenace phase of 6 months, and they received either 20 mg esomeprazole every day or 40 mg esomeprazole on demand,” explained Dr. Leopold Engels, gastroenterologist, Maasland Hospital, Sittard, The Netherlands, here at the 11th United European Gastroenterology Week. Five hundred and twenty eight patients received the daily treatment and 524 the on-demand treatment. Patients were randomised to these groups irrespective of entry symptoms. The end point was patient satisfaction after six months plus the quality of life attained with each treatment strategy. This was estimated using the Quality of Life in Reflux and Dyspepsia [QOLRAD] questionnaire.”At each outpatient visit they filled in eight pages of questions and therefore we could construct a [quality of life picture],” explained Dr. Engels.The median time to sustained symptom relief was 3 days for the RO patients and 4 days for the NED patients. 89.6% and 88.4% (no significant difference) of the continuous and on-demand treatment patients declared they were satisfied with their treatment during the study period.However, the overall quality of life of the daily treatment patients was significantly better. Those taking the daily dose reported greater vitality (P < .0001), better physical and social functioning (P < .0001 for NED patients and P < .001 for RO patients), had less food and drink problems (P < .0001), had far fewer sleep disturbances (P < .001), and suffered less emotional distress (P < .001 for NED patients and P < .01 for RO patients)."When the doctor has very satisfied patients, he could put emphasis on the 40 mg on-demand strategy, but when [he thinks he has to do the best to improve his patient's quality of life] he should prescribe the 20 mg every day formula," concluded Dr. Engels.[Study title: Esomeprazole Continues Versus On Demand Maintenance Therapy In 1052 Gastro-Oesophageal Reflux Disease Patients: Similar Satisfaction But Superior Quality Of Life For Once Daily Treatment. Abstract Tue-G-056]