'Zo nodig'-gebruik van zuurremmende middelen bij refluxziekte

- Although proton pump inhibitors and H₂-receptor antagonists are usually prescribed for continuous use by patients with gastro-oesophageal reflux disease, at least 50 of such patients do not take their medication daily and some take it only sporadically.

- On-demand treatment with proton pump inhibitors or H₂-receptor antagonists is safe and cost-effective.

- Indications are: (a) incidental reflux episodes of short duration, (b) periodic reflux lasting several weeks or months, (c) chronic reflux not requiring continuous treatment. On-demand treatment is unsuitable for patients with reflux disease who either require daily medication or in whom the maximal dosage is insufficient.

- There are three types of on-demand treatment. Type 1: use of medication only in case of incidental symptoms. Type 2: continuous medication for 2-4 weeks when symptoms appear. Type 3: continuous use because of chronic symptoms, but the interval between doses is determined by the patient on the basis of his symptoms.

- All antacids can in principle be used for on-demand treatment; for type 3 treatment, antacids with a rapid onset of action are preferred.

- A favourable response to the two weeks of initial therapy is a good predictor for successful on-demand treatment.