2017 Volume 68 Issue 3 Pages 222-226
A 72-year-old man with proton pump inhibitor (PPI)-resistant gastroesophageal reflux disease (GERD) had been complaining of ructus, sore throat, and mid-back pain during the night despite the administration of the standard dose of PPI. As his symptoms improved rapidly after taking bukuryoin, he discontinued PPI on his own judgment. However, his nocturnal symptoms relapsed. Adding hangeshashinto before bedtime was so effective that he could cease using PPI. However, upper endoscopy revealed poor mucosal findings such as Grade D in the Los Angeles classification of GERD ; we increased the dose of hangeshashinto to 3 times a day and added orengedokuto before going to bed. His subjective symptoms completely disappeared, however, we could not operate endoscopy again during our intervention. It seems that not only rikkunshito which is recommended in the guideline for GERD but also other Kampo formulas were possibly effective to PPI-resistant GERD. Although endoscopic findings are not always correlative to their subjective complaints, we need further discussion on the endpoint of Kampo therapy to prevent complications.
