Objective: On-demand treatment protocols in the maintenance treatment of gastroesophageal reflux disease (GERD) are cost-efficient and easy-to-use treatments.This study aimed to compare the efficacies of H2 receptor antagonists (H 2 RA) and proton pump inhibitors (PPI) in on-demand treatment of GERD. Methods:Patients with persistent GERD symptoms were enrolledbetween January-November 2015 and were randomly separated into two equal groups. The patients in the first group were commenced on ranitidine 300 mg as H2RA and the patients in the second group were commenced on pantoprazole 40 mg. A 4-point Likert-type scale generated by the researchers was applied to evaluate the frequencies of reflux symptoms and their impacts on activities of life and business life.Results: Fifty-two patients were included, of whom 26 (50.0%) were in the PPI group and 26 (50.0%) were in the H 2 RA group. There were no significant differences between the study groups both before and after treatment in terms of the severity of reflux symptoms. There were significant decreases in the H2RA group in terms of the domains of retrosternal burning sensation, regurgitation, nausea and vomiting, and burping (p=0.036, p=0.027, p=0.020, and p=0.038, respectively). Conclusion:PPIs and H2RAs were both effective in maintaining symptom control and improving the limitations in work or activities in on-demand treatment.Nonetheless, the higher amount of the medication use in the H2RA group compared with the PPI group led us to conclude that using PPIs during on-demand treatment might be more appropriate than using H2RA in this setting.

BackgroundFamilial Mediterranean fever (FMF) is characterized by recurrent attacks of polyserositis. Delay in treatment may lead to recurrent attacks and amyloidosis.ObjectivesIn this study, we aimed to evaluate clinical features of patients diagnosed early and compared to those diagnosed lateMethodsWe enrolled 143 FMF patients over the age of 18 who met Tel-Hashomer Criterias into the study. Demographic features of the patients, duration of education, smoking habits, family history of FMF disease and amyloidosis,; features, duration and frequency of FMF attacks; age at first FMF attack; age at first admittance to a specialist, time between first FMF attack to first admittance to a specialist and which medical specialities patients admitted for their symptoms were recorded with face to face survey method. Else, MEFV gene mutations of the patients, time between first admittance to a specialist to diagnosis, clinical decision and judgement of the specialists at the time of diagnosis were obtained from hospital's medical recording system. Early diagnosis was defined as within three years after the first symptom.ResultsMean diagnostic delay was 12.03±10.43 years. Age at first FMF attack (p=0.020), time between first FMF attack to first admittance to a specialist (p=0.003) and first admittance to a specialist after year 2000 (p=0.001) were found statistically important related with early diagnosis in a regression model. MEFV mutation was the only method that had an influence on the decision making of doctors in the diagnosis of FMF especially after year 2000.ConclusionsInstead of demographic, clinical and genetic differences, early diagnosis may related with increased patient awareness about the disease. Furthermore, availability of MEFV mutation may influence doctors' decision making positively for facilitating early diagnosis of FMF and may replace clinical features. But, this may lead to failures in diagnosis in gene-negative FMF cases.ReferencesBen-Chetrit, E. M. Levy (1998) Familial Mediterranean fever.Lancet 351:659–64Livneh, A., P. Langevitz, D. Zemer, N. Zaks, S. Kees, T. Lidar, A. Migdal, S. PadehM. Pras (1997) Criteria for the diagnosis of familial Mediterranean fever.Arthritis Rheum 40:1879–85Disclosure of InterestNone declared