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01-08-2016 | Special Article

Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015

Authors: Katsuhiko Iwakiri, Yoshikazu Kinoshita, Yasuki Habu, Tadayuki Oshima, Noriaki Manabe, Yasuhiro Fujiwara, Akihito Nagahara, Osamu Kawamura, Ryuichi Iwakiri, Soji Ozawa, Kiyoshi Ashida, Shuichi Ohara, Hideyuki Kashiwagi, Kyoichi Adachi, Kazuhide Higuchi, Hiroto Miwa, Kazuma Fujimoto, Motoyasu Kusano, Yoshio Hoshihara, Tatsuyuki Kawano, Ken Haruma, Michio Hongo, Kentaro Sugano, Mamoru Watanabe, Tooru Shimosegawa

Published in: Journal of Gastroenterology | Issue 8/2016

Abstract

As an increase in gastroesophageal reflux disease (GERD) has been reported in Japan, and public interest in GERD has been increasing, the Japanese Society of Gastroenterology published the Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009. Six years have passed since its publication, and there have been a large number of reports in Japan concerning the epidemiology, pathophysiology, treatment, and Barrett’s esophagus during this period. By incorporating the contents of these reports, the guidelines were completely revised, and a new edition was published in October 2015. The revised edition consists of eight items: epidemiology, pathophysiology, diagnosis, internal treatment, surgical treatment, esophagitis after surgery of the upper gastrointestinal tract, extraesophageal symptoms, and Barrett’s esophagus. This paper summarizes these guidelines, particularly the parts related to the treatment for GERD. In the present revision, aggressive proton pump inhibitor (PPI) maintenance therapy is recommended for severe erosive GERD, and on-demand therapy or continuous maintenance therapy is recommended for mild erosive GERD or PPI-responsive non-erosive GERD. Moreover, PPI-resistant GERD (insufficient symptomatic improvement and/or esophageal mucosal break persisting despite the administration of PPI at a standard dose for 8 weeks) is defined, and a standard-dose PPI twice a day, change in PPI, change in the PPI timing of dosing, addition of a prokinetic drug, addition of rikkunshito (traditional Japanese herbal medicine), and addition of histamine H2-receptor antagonist are recommended for its treatment. If no improvement is observed even after these treatments, pathophysiological evaluation with esophageal impedance-pH monitoring or esophageal manometry at an expert facility for diseases of the esophagus is recommended.

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Title: Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015
Authors: Katsuhiko Iwakiri
Yoshikazu Kinoshita
Yasuki Habu
Tadayuki Oshima
Noriaki Manabe
Yasuhiro Fujiwara
Akihito Nagahara
Osamu Kawamura
Ryuichi Iwakiri
Soji Ozawa
Kiyoshi Ashida
Shuichi Ohara
Hideyuki Kashiwagi
Kyoichi Adachi
Kazuhide Higuchi
Hiroto Miwa
Kazuma Fujimoto
Motoyasu Kusano
Yoshio Hoshihara
Tatsuyuki Kawano
Ken Haruma
Michio Hongo
Kentaro Sugano
Mamoru Watanabe
Tooru Shimosegawa
Publication date: 01-08-2016
Publisher: Springer Japan
Published in: Journal of Gastroenterology / Issue 8/2016
Print ISSN: 0944-1174
Electronic ISSN: 1435-5922
DOI: https://doi.org/10.1007/s00535-016-1227-8

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