***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: To assess the comparative efficacy of omeprazole 20 mg , a proton pump inhibitor , versus ranitidine 150 mg twice a day , an H2-receptor antagonist , in healing duodenal ulcers we performed a r and omized , double-blind , multicenter trial in 309 patients with endoscopically diagnosed ulcers . Patients were treated for up to four weeks and were seen at week 2 and at week 4 , if unhealed at week 2 , for determination of ulcer status by endoscopy , review of daily self- assessment symptom diaries , and clinical laboratory including fasting serum gastrin . Gastrin levels were repeated two weeks after cessation of study medication . Evaluation of baseline demographic and laboratory parameters demonstrated no significant differences between the two groups at entry . At week 2 , 42 % of the omeprazole and 34 % of the ranitidine-treated patients were healed ( P = NS ) . At week 4 , there was a 19 % advantage in ulcer healing for the omeprazole-treated patients in comparison to those treated with ranitidine ( 82 % vs 63 % , respectively , P<0.05 ) . Healing of ulcers ≥1.0 cm occurred in 83 % of those treated with omeprazole versus 37 % treated with ranitidine ( P<0.01 ) . There were no significant differences in rate of pain relief or incidence of clinical laboratory abnormalities . Mean fasting serum gastrin value during treatment increased over the baseline in both groups , ( P<0.05 ) . The percent change was significantly greater with omeprazole but few patients had elevations above the upper limit of normal for the assay . Both drugs were well tolerated . Omeprazole 20 mg demonstrated superiority in healing duodenal ulcers at four weeks in comparison to ranitidine 150 mg twice daily and was more effective in healing ulcers > -1.0 cm In patients with reflux disease , pH monitoring has shown that omeprazole virtually eliminates oesophageal exposure to a pH of less than 4 . Motility studies concurrent with pH monitoring have indicated that reflux continues on omeprazole , its effect on acid exposure being entirely dependent on elevation of gastric pH. Omeprazole and placebo have been compared in 64 patients with erosive or ulcerative oesophagitis ; the 4-week healing rates were 81 % with omeprazole , 20 mg or 40 mg daily , and 6 % with placebo . The efficacies of omeprazole at doses of 20 mg and 40 mg daily , were then compared in 164 patients . At 4 weeks , oesophagitis was healed in 70 % and 82 % of patients for the 20 mg and 40 mg doses respectively ( p = 0.05 ) . Eight-week healing rates ( 79 % for 20 mg and 85 % for 40 mg ) did not differ significantly . Symptom response was excellent for both doses . Relapse of oesophagitis was determined over 6 months for patients healed with omeprazole .  Relapse was shown to occur in 88 of 107 patients by 6 months . Omeprazole is a highly effective treatment for erosive/ulcerative peptic oesophagitis , 40 mg daily being marginally superior to 20 mg . Relapse is almost inevitable within 6 months of cessation of therapy OBJECTIVES : The aim of this dose-response study was to compare the effectiveness of 10 mg , 20 mg , and 40 mg of pantoprazole with that of placebo tablets in the healing and symptom relief of gastroesophageal reflux disease associated with erosive esophagitis , and to determine the optimal dose . METHODS : A total of 603 patients with endoscopically confirmed ( Hetzel-Dent scale ) erosive esophagitis of grade 2 ( 64.5 % ) or grade s 3 or 4 ( 35.3 % ) were enrolled in a double-blind , multicenter study and r and omly assigned to receive pantoprazole ( 10 mg , 20 mg , or 40 mg ) or placebo , administered once daily in the morning , for 4 or 8 wk depending on healing . RESULTS : The healing rates after 4 wk for placebo and pantoprazole 10 mg , 20 mg , and 40 mg/day were 14 % , 42 % , 55 % , and 72 % , respectively ( p < 0.001 for all doses of pantoprazole vs placebo ) . Cumulative healing rates after 8 wk for placebo and pantoprazole 10 mg , 20 mg , and 40 mg/day were 33 % , 59 % , 78 % , and 88 % , respectively ( p < 0.001 for all doses of pantoprazole vs placebo ) . The 40-mg pantoprazole dose produced greater rates of healing and earlier healing of esophagitis than either the 10- or 20-mg dose , regardless of severity . Pantoprazole , at any dose , was significantly more effective than placebo in relieving reflux symptoms . Patients on pantoprazole 40 mg experienced relief of symptoms on day 1 of treatment . No serious treatment-related adverse events occurred . CONCLUSIONS : Pantoprazole was safe and effective for healing erosive esophagitis and provided rapid symptomatic relief . These results indicate that pantoprazole offers a new option for treatment of  erosive esophagitis .  Among the three doses studied , the 40-mg dose was the most effective On-dem and therapy is effective for maintaining symptoms control in nonerosive gastroesophagealreflux disease ( GERD ) . Our aim was to assess the clinical effectiveness of on-dem and therapy witha proton pump inhibitor ( PPI ) in mild GERD ( nonerosive and low- grade esophagitis ) , its impact onhealth-related quality of life ( HRQoL ) , and the degree of patient satisfaction . Fifty-five patients ( 17with nonerosive GERD and 38 with low- grade esophagitis ) were treated with rabeprazole , 20 mg/day . The healed patients started on-dem and therapy . We evaluated symptoms ( clinical question naire),HRQoL ( SF-36 question naire ) , and patient satisfaction ( visual analogue scale ) . Of the 55 patients included , 51 started on-dem and therapy for 6 months . Symptom control ( heartburn < twice a week)was achieved in over 85 % of the patients . The mean ( SD ) amount of PPI used was 0.3 (0.19)tablet/day . The patient satisfaction score at the end of the acute phase was 98 ( range , 0 - 100 ) and remained high ( 90 ; range , 10 - 100 ) and stable during on-dem and therapy . Short-term treatmentnormalized the HRQoL scores , which were subsequently maintained during on-dem and therapy . On-dem and therapy is useful for the clinical management of patients with mild GERD , allowingadequate symptoms control , limiting PPI consumption , and affording important patient satisfactionwith normalization of This study determined the optimal maintenance dose of omeprazole in reflux oesophagitis . One hundred and ninety three patients rendered asymptomatic and healed after four or eight weeks omeprazole  were r and omised double blind to 10 mg omeprazole once daily ( n = 60 evaluable ) , 20 mg omeprazole once daily ( n = 68 ) , or placebo ( n = 62 ) for one year or until symptomatic relapse . Each omeprazole regimen was superior to placebo in preventing both symptomatic relapse ( life table analysis , p < 0.001 ) and endoscopically verified relapse ( p < 0.001 ) . At 12 months , the life table endoscopic remission rates ( proportions of patients without grade > or = 2 oesophagitis ) were : 50 % ( 95 % confidence intervals 34 to 66 % ) with 10 mg omeprazole once daily , 74 % ( 62 to 86 % ) with 20 mg omeprazole once daily , and 14 % ( 2 to 26 % ) with placebo . At 12 months , the life table symptomatic remission rates ( proportions of patients asymptomatic or with mild symptoms ) were : 77 % ( 64 to 89 % ) with 10 mg omeprazole once daily , 83 % ( 73 to 93 % ) with 20 mg omeprazole once daily , and 34 % ( 16 to 52 % ) with placebo . Both 10 mg and 20 mg omeprazole once daily were effective in prolonging the remission of reflux oesophagitis : 10 mg may be appropriate to start longterm treatment , though the existence of a dose response relation means that 20 mg once daily may be effective in patients for whom 10 mg once daily is suboptimal Background Evidence suggests that rates of gastroesophageal reflux disease are increasing in the Asia – Pacific region , where patients tend to have predominantly non-erosive reflux disease as opposed to erosive ( reflux ) esophagitis . At present , data for the responsiveness of non-erosive reflux disease to proton pump inhibition are scant . We aim ed to study esomeprazole for the treatment of non-erosive reflux disease in Chinese patients . Methods Patients with a clinical diagnosis of gastroesophageal reflux , and a locally vali date d reflux index , the Chinese GerdQ , of equal to or greater than 12 were recruited and r and omized to receive esomeprazole 20 mg daily or placebo for 8 weeks . Reflux index scores , quality of life ( SF-36 ) , and the hospital anxiety and depression ( HAD ) scale and symptom relief were evaluated before , during , and after treatment . Results A total of 175 patients were r and omized . Patients in the esomeprazole group ( n = 85 ) demonstrated statistically significant reductions in their GerdQ index , from 19.45 to 15.37 and to 14.32 ( p = 0.013 , p = 0.005 ) at weeks 4 and 8 , respectively . Compared to placebo at week 8 , 57.1 % of patients on esomeprazole found that their symptoms had resolved or were acceptable compared with 37.2 % in the placebo group ( p = 0.001 ) . There were no statistically significant differences in overall quality -of-life measures or the HAD scale related to treatment . Conclusions This study suggests that esomeprazole is efficacious in treating Chinese patients with non-erosive reflux disease Objective . To investigate whether patients on long-term antisecretory medication  need to continue treatment to control symptoms . Methods . A double-blinded r and omised placebo-controlled trial in general practice s in Denmark . Patients aged 18–90 who were treated with antisecretory drugs on a long-term basis were r and omized to esomeprazole 40 mg or identical placebo . Outcome measures were time to discontinuation with trial medication due to failed symptom control analysed as survival data . The proportion of patients stopping trial medication during the one-year follow-up was estimated . Results . A total of 171 patients were included with a median prior duration of antisecretory treatment of four years ( range : 0.5 to 14.6 years ) . 86 patients received  esomeprazole 40 mg and 85 patients received placebo . At 12 months , statistically significantly more patients in the placebo group had discontinued ( 73 % ( 62/85 ) ) compared with the esomeprazole group ( 21 % ( 18/86 ) ; p < 0.001 ) . Conclusions . Long-term users of antisecretory drugs showed a preference for the active drug compared to placebo . However , 27 % of patients continued on placebo throughout the study and did not need to reinstitute usual treatment . One in five patients treated with esomeprazole discontinued trial medication due to unsatisfactory symptom control . Discontinuation of antisecretory treatment should be considered in long-term users of antisecretory drugs . This trial is registered with Trial registration Clinical Trials.gov ID : NCT00120315 Background The use of proton pump inhibitors ( PPIs ) is extensive . While the incidence of new treatments remains stable , the prevalence of long‐term treatment is rising . Studies have shown that up to 70 % of patients on chronic acid suppression lack a verified indication for treatment BACKGROUND & AIMS Many patients with gastroesophageal reflux disease ( GERD ) take a proton pump inhibitor ( PPI ) twice daily to control symptoms . Once-daily dexlansoprazole modified release ( MR ) has a dual-delayed release formulation , making it attractive for step-down management of patients whose symptoms are well controlled on twice-daily PPIs . We investigated whether step-down to once-daily dexlansoprazole controls heartburn in patients with GERD who were receiving twice-daily PPI therapy . METHODS Patients 18 years and older taking a twice-daily PPI for symptom control were enrolled ( n = 178 ) in a single-blind , multicenter study ; 163 patients completed the study and 142 patients met criteria for the 
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There was also low quality evidence that on-dem and PPI use may be associated with reduced participant satisfaction compared with continuous PPI use .
AUTHORS ' CONCLUSIONS In people with mild GERD , on-dem and deprescribing may lead to an increase in GI symptoms ( e.g. dyspepsia , regurgitation ) and probably a reduction in pill burden .