Abstract
Gastroesophageal reflux disease (GERD) is said to be prevalent in Europe and the USA. However, even in Japan the incidence is steadily increasing and is related to westernized eating habits, increasing obesity, increase in acid secretion, and reduction of the Helicobacter pylori infection rate. In GERD patients, prevention of regurgitation from the stomach to the esophagus or emptying is affected by esophageal dyskinesia, mechanical or functional abnormality of the lower esophageal sphincter, or delayed esophageal clearance and gastric emptying. Quality of life (QOL) is severely worsened. Non erosive reflux disease (NERD) and mild reflux esophagitis are overwhelmingly found in Japan, but these mild types of GERD do not tend to progress to severe GERD. Therefore, the treatment objective is improvement of subjective symptoms such as heartburn and acid regurgitation and of daily QOL. The most useful treatment is inhibition of gastric-acid secretion, but when the effectiveness of this treatment is modest, it is difficult to treat. Symptoms do not correlate with esophageal mucosal injury, and efficacy of the proton pump inhibitor (PPI) in NERD is said to be around 50%. Recently, evidence of Kampo herbal medicine has been obtained in GERD treatment. Rikkunshito has been shown to improve esophageal clearance as well as gastric emptying and adaptive relaxation without inhibiting gastric acid secretion. It may be effective for symptom improvement in GERD, particularly NERD patients.
