Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021
JSGE · 2022 · Japan
Source and licence
- Authors
- Katsuhiko Iwakiri, Yasuhiro Fujiwara, Noriaki Manabe et al.
- Title
- Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021
- Journal
- Journal of Gastroenterology, 2022
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC8938399
Licence statement of the original publication
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Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
Algorithms for the diagnosis and treatment of GERD
- Diagnosis (Fig. 1a): When GERD is suspected based on a clinical assessment, 2 types of algorithms are proposed: (i) endoscopy is initially performed before the administration of PPI, and (ii) the administration of PPI is initiated without endoscopy. In cases on which endoscopy is initially performed, GERD is subdivided into severe RE (grade C or D of Los Angeles (LA) classification), mild RE (grade A or B of LA classification), NERD, and other diseases, and a treatment algorithm (Fig. 1b–d) is proposed for each.
Summary of medical treatment
- Comment: Since severe RE has a higher acid reflux rate than mild RE [12], the recurrence of esophageal mucosal injury is expected without maintenance therapy [75]. Severe RE is also associated with a high risk of bleeding and stenosis (grade C odds ratio 15.38; 95% CI 8.62–28.37, grade D odds ratio: 71.49; 95% CI 37.47–142.01) [8]. Therefore, continuous gastric acid suppression is necessary for long-term management.
Abstract
In Japan, with the increasing prevalence of gastroesophageal reflux disease (GERD) and growing public interest, the Japanese Society of Gastroenterology issued Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009 and a revised 2nd edition in 2015. A number of studies on GERD were subsequently conducted in Japan and abroad, and vonoprazan, a potassium-competitive acid blocker (P-CAB), became available for the first time in Japan in February 2015. The revised 3rd edition (Japanese edition), which incorporates new findings and information, was published in April 2021. These guidelines are summarized herein, particularly sections related to the treatment of GERD. The important clinical issues addressed in the present revision are (i) the introduction of treatment algorithms that classify GERD into reflux esophagitis and non-erosive reflux disease, (ii) the clarification of treatment algorithms based on to the severity of reflux esophagitis, and (iii) the positioning of vonoprazan in the treatment for GERD. The present guidelines propose vonoprazan as the initial/maintenance treatment for severe reflux esophagitis. They also recommend vonoprazan or PPI as an initial treatment for mild reflux esophagitis and recommended PPI and proposed vonoprazan as maintenance treatment. These updated guidelines offer the best clinical strategies for GERD patients in Japan and hope that they will be of global use for the diagnosis and treatment for GERD.
Contents of the original publication
The section headings of the original.
- Introduction
- Definitions of terms used in the present guidelines
- GERD
- GER
- Proton pump inhibitor (PPI)-resistant GERD
- P-CAB-resistant GERD
- Postoperative esophagitis
- Barrett’s esophagus (BE)
- Algorithms for the diagnosis and treatment of GERD
- Summary of epidemiology
- Summary of pathophysiology
- Summary of diagnosis
- Summary of medical treatment
- Development of carcinoid tumors
- Influence on gastrointestinal infections and intestinal bacteria
- Drug interactions
- Summary of surgical treatment
- Summary of postoperative esophagitis
- Summary of atypical or extra-esophageal symptoms
- Summary of BE
- Appendix
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