SOURCE: Peura D, Le Moigne A, Pollack C, et al. A 14-day regimen of esomeprazole 20 mg/day for frequent heartburn: Durability of effects, symptomatic rebound, and treatment satisfaction. Postgrad Med 2016;128:577-583.

Esomeprazole is available over the counter as Nexium 24 (20 mg) and by prescription as Nexium 40 mg. More than 75% of patients with uncomplicated gastroesophageal reflux disease (GERD) enjoy symptomatic relief with a four- to eight-week course of prescription esomeprazole 40 mg daily, and many of the remainder find improvement with twice-daily dosing.

Might even a lower esomeprazole dose over the short term be effective? To test this hypothesis, Peura et al performed two clinical trials in which they randomized subjects to 20 mg esomeprazole or placebo daily for two weeks. The remarkable thing about the patient population is that subjects were excluded if they received a confirmed diagnosis of GERD or erosive esophagitis or were on a prescription for GERD medications. One might perceive such patients as those with insufficiently burdensome symptoms to seek clinician care for relief. Study subjects reported frequent heartburn at least two days/week for the past month.

Daily low-dose esomeprazole (20 mg) was statistically significantly superior to placebo for symptom relief during 14 days of administration and the week following discontinuation, without evidence of rebound. When patients do not achieve satisfactory symptomatic relief from GERD with low-dose treatment, appropriate courses of action include increasing the dose, switching to another proton pump inhibitor, adding an H2 antagonists, or adding an alginate.