Comparison of these benchmarks with actual wait times will identify limitations in access to digestive heath care in Canada. These recommendations should be considered targets for future health care improvements and are not clinical practice guidelines.

SUMMARY BackgroundMalnutrition is a common and clinically significant problem in patients with cirrhosis. The impact of nutritional therapy remains unclear.

Summary Aim : To evaluate treatment efficacy using objective quality criteria. Methods : A systematic review was performed of randomized controlled trials of endoscopically investigated dyspepsia (1979–2003) using the Jadad score and Rome II guidelines. The Jadad score differentiated studies as ‘high quality’ (score 4–5/5) vs. ‘poor quality’ (score 1–3/5). Three key Rome II guidelines on study design (cut‐off of 0/3 or > 0/3) were also compared with the Jadad score. Results : Poor quality trials suggested a benefit of prokinetic therapy [relative risk (RR) of remaining dyspeptic, 0.47; 95% confidence interval (CI), 0.39–0.56), which was not confirmed in high quality trials (RR, 1.0; 95% CI, 0.84–1.19). There was a marked benefit of H2‐receptor antagonist therapy in poor quality trials (RR, 0.68; 95% CI, 0.61–0.76), but a marginal benefit in good quality trials (RR, 0.87; 95% CI, 0.79–0.97). Trial quality did not affect the small statistically significant benefit seen with Helicobacter pylori eradication. Two high quality trials suggested a limited benefit with the use of proton pump inhibitors, with no poor quality trials to provide a comparison. Separation of the studies by the Rome II criteria had a similar impact on the calculated treatment estimates. Conclusions : The magnitude of benefit of prokinetic and H2‐receptor antagonist therapies reported in previous meta‐analyses has been over‐estimated. The quality of trials has an impact on the efficacy estimates of treatment. The Rome II criteria for study methodology may be appropriate for judging study quality.

The following pages summarize the proceedings of a symposium held in May 2006 on the emerging role of on-demand therapy for gastroesophageal reflux disease (GERD). Medical therapy for GERD has undergone significant change in recent years with the advent of effective, but expensive, antisecretory agents. On-demand (patient-driven) therapy is attractive to payers and patients, because it appears to be both cost-effective and convenient. Many individuals appear to accept occasional symptomatic breakthrough in exchange for personal control of their disease. On-demand therapy should be distinguished from intermittent therapy, which is either patient- or physician-driven, but which requires intermittent episodes of continuous therapy followed by discontinuation until symptoms recur. Proton pump inhibitors appear to be effective on-demand agents despite theoretical pharmacodynamic limitations for this class of drug. The available data support the use of on-demand therapy for GERD in uninvestigated reflux disease, nonerosive reflux disease, and possibly mild esophagitis as well. On-demand therapy should not be considered for patients with severe esophagitis.