Abstract
Gastroesophageal reflux disease (GERD) including reflux esophagitis is recently increasing in Japan, and the guideline for GERD in Japan was reported in 2009. One cause of GERD is increased gastric acid secretion due to increased protein intake, decreased intake of fishes and salt, decreasing rate of Helicobacter pylori infection, or an increased use of low-dose aspirin and NSAIDs. Another cause is increased reflux of gastric juice, which may be caused by the lower esophageal sphincter dysfunction due to increased rates of hiatus hernia, bending of the back, increased fat intake, increased doses of calcium blockers and nitrates or obesity. GERD sometimes disturbs food intake, sleep, work, and QOL and is associated with functional dyspepsia or irritable bowel syndrome. GERD is also related Barrett's esophagus and Barrett's adenocarcinoma. Most cases of GERD can be diagnosed by symptoms, and proton pump inhibitors (PPIs) are efficacious for diagnostic therapy for GERD. They are the first choice of treatment for GERD. If one of the PPIs is ineffective, another may be effective. The change of administration time, dose division, and dose level might also be considered. Additional Rikkunshito, mucoprotecting drugs, or psychotropic drugs is sometimes useful. Esophageal pH-impedance monitoring and high- resolution manometry in addition to upper gastrointestinal endoscopy can be useful for differentiating cases refractory to PPI. Reducing body weight and lifting of the head in bed is useful for preventing GERD. Laparoscopic antireflux surgery is considered in cases refractory to medication and when patients hope to avoid medication for a long time.
Not only treatment but also prophylaxis of GERD are important, and they are expected to be established.
