[Proton pump inhibitors according to need. Always for heartburn]

Gastroesophageal reflux disease (GERD) is one of the most common medical problems. The large majority of patients so affected have no endoscopically evident disease, or only mild erosive reflux esophagitis. Since both forms of GERD are probably non-progressive, on-demand therapy aimed at adequately controlling symptoms is safe treatment. Proton pump inhibitors (PPI) are the drugs of choice for acute and long-term treatment. In 1999, the first study reporting on on-demand therapy with omeprazole was published. A clear superiority over placebo was found, as was also dependence of the effect on the dose. In the recent past, publications have reported on on-demand therapy with the s-isomer of omeprazole--esomeprazole. With success rates of around 90%, on-demand therapy has proven to be highly effective. On average, the patients take one 20 mg tablet of esomeprazole on every third to fourth day.