Skip to main content
Log in

Gastro-esophageal reflux disease: the recent trend in Japan

  • Clinical Review
  • Published:
Clinical Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Gastro-esophageal reflux disease (GERD) has increased in Japan, as in other countries. This is probably due to increased acid secretion among Japanese due to Westernized foods and lifestyle as well as decreased prevalence of Helicobacter pylori infection. Proton pump inhibitor (PPI) is mainly used for treatment of this condition. PPI has recently been approved for treatment of nonerosive reflux disease (NERD) in Japan. NERD is known to have different characteristics to GERD, and effectiveness of PPI in NERD patients is lower than that in reflux esophagitis patients. Regarding therapeutic benefit of treatment, a recent study showed that PPI improved quality of life (QOL) of GERD patients also in Japan. For diagnosis of reflux esophagitis in Japan, we use a unique classification, a modified Los Angeles (LA) classification, which includes minimal change (grade M esophagitis) as one distinct criteria. However, recent studies from Japan showed poor interobserver agreement in diagnosis of grade M, although excess acid reflux in minimal change was shown in another study. Our definition of Barrett’s esophagus is also different from that in the West. Nationwide consensus on diagnosis of reflux esophagitis and Barrett’s esophagus should be achieved in Japan, preferably consistent with world standard.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Vakil N, van Zanten SV, Kahrilas P, Dent J, Jones R. The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am J Gastroenterol. 2006;101(8):1900–20.

    Article  PubMed  Google Scholar 

  2. Miwa H. New conceptual framework of GERD—especially regarding pathophysiology of NERD and Barrett’s esophagus (in Japanese with English abstract). Nippon Shokakibyo Gakkai Zasshi. 2006;103(8):901–10.

    PubMed  Google Scholar 

  3. El-Serag HB, Sonnenberg A. Opposing time trends of peptic ulcer and reflux disease. Gut. 1998;43(3):327–33.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Mishima I, Adachi K, Arima N, Amano K, Takashima T, Moritani M, et al. Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the Japanese. Scand J Gastroenterol. 2005;40(9):1005–9.

    Article  PubMed  Google Scholar 

  5. Manabe N, Haruma K, Mihara M, Ohshima T, Miwa H, Iwakiri R, et al. The increasing incidence of reflux esophagitis during the past 20 years in Japan. Gastroenterology 1999;116(4):A244.

    Google Scholar 

  6. Ohara S, Kouzu T, Kawano T, Kusano M. Nationwide epidemiological survey regarding heartburn and reflux esophagitis in Japanese. Nippon Shokakibyo Gakkai Zasshi. 2005;102(8):1010–24.

    PubMed  Google Scholar 

  7. Okamoto K, Iwakiri R, Mori M, Hara M, Oda K, Danjo A, et al. Clinical symptoms in endoscopic reflux esophagitis: evaluation in 8,031 adult subjects. Dig Dis Sci. 2003;48(12):2237–41.

    Article  PubMed  Google Scholar 

  8. Shimizu T, Matsui T, Furukawa K, Oshige K, Mitsuyasu T, Kiyomizu A, et al. A prospective study of the prevalence of gastroesophageal reflux disease and confounding factors. J Gastroenterol. 2005;40(9):866–72.

    Article  Google Scholar 

  9. Kinoshita Y, Kawanami C, Kishi K, Nakata H, Seino Y, Chiba T. Helicobacter pylori independent chronological change in gastric acid secretion in the Japanese. Gut. 1997;41(4):452–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Asaka M, Kimura T, Kudo M, Takeda H, Mitani S, Miyazaki T, et al. Relationship of Helicobacter pylori to serum pepsinogens in an asymptomatic Japanese population. Gastroenterology. 1992;102(3):760–6.

    Article  CAS  PubMed  Google Scholar 

  11. Fujisawa T, Kumagai T, Akamatsu T, Kiyosawa K, Matsunaga Y. Changes in seroepidemiological pattern of Helicobacter pylori and hepatitis A virus over the last 20 years in Japan. Am J Gastroenterol. 1999;94(8):2094–9.

    Article  CAS  PubMed  Google Scholar 

  12. Raghunath A, Hungin AP, Wooff D, Childs S. Prevalence of Helicobacter pylori in patients with gastro-oesophageal reflux disease: systematic review. BMJ 2003;326(7392):737.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Miwa H, Hojo M, Ohkusa T, Sato N. Gastroesophageal reflux diseases and Helicobacter pylori infection. Karnataka Med J. 2003;73(2):8–12.

    Google Scholar 

  14. Matsuhisa T, Matsukura N, Yamada N. Topography of chronic active gastritis in Helicobacter pylori-positive Asian populations: age-, gender-, and endoscopic diagnosis-matched study. J Gastroenterol. 2004;39(4):324–8.

    Article  PubMed  Google Scholar 

  15. Naylor GM, Gotoda T, Dixon M, Shimoda T, Gatta L, Owen R, et al. Why does Japan have a high incidence of gastric cancer? Comparison of gastritis between UK and Japanese patients. Gut. 2006;55(11):1545–52.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Yoshiike N, Matsumura Y, Yamaguchi M, Seino F, Kawano M, Inoue K, et al. Trends of average intake of macronutrients in 47 prefectures of Japan from 1975 to 1994—possible factors that may bias the trend data. J Epidemiol. 1998;8:160–7.

    Article  CAS  PubMed  Google Scholar 

  17. Yoshiike N, Seino F, Tajima S, Arai Y, Kawano M, Furuhata T, et al. Twenty-year changes in the prevalence of overweight in Japanese adults: the National Nutrition Survey 1976–95. Obes Rev. 2002;3(3):183–90.

    Article  CAS  PubMed  Google Scholar 

  18. Yamaguchi T, Sugimoto T, Yamada H, Kanzawa M, Yano S, Yamauchi M, et al. The presence and severity of vertebral fractures is associated with the presence of esophageal hiatal hernia in postmenopausal women. Osteoporos Int. 2002;13(4):331–6.

    Article  CAS  PubMed  Google Scholar 

  19. Takemitsu Y, Harada Y, Iwahara T, Miyamoto M, Miyatake Y. Lumbar degenerative kyphosis. Clinical, radiological and epidemiological studies. Spine. 1988;13(11):1317–26.

    Article  CAS  PubMed  Google Scholar 

  20. Fujimoto K, Iwakiri R, Okamoto K, Oda K, Tanaka A, Tsunada S, et al. Characteristics of gastroesophageal reflux disease in Japan: increased prevalence in elderly women. J Gastroenterol. 2003;38(Suppl 15):3–6.

    PubMed  Google Scholar 

  21. El-Serag HB, Johanson JF. Risk factors for the severity of erosive esophagitis in Helicobacter pylori-negative patients with gastroesophageal reflux disease. Scand J Gastroenterol. 2002;37(8):899–904.

    Article  CAS  PubMed  Google Scholar 

  22. Lind T, Havelund T, Carlsson R, Anker-Hansen O, Glise H, Hernqvist H, et al. Heartburn without oesophagitis: efficacy of omeprazole therapy and features determining therapeutic response. Scand J Gastroenterol. 1997;32(10):974–9.

    Article  CAS  PubMed  Google Scholar 

  23. Carlsson R, Dent J, Watts R, Riley S, Sheikh R, Hatlebakk J, et al. Gastro-oesophageal reflux disease in primary care: an international study of different treatment strategies with omeprazole. Eur J Gastroenterol Hepatol. 1998;10(2):119–24.

    Article  CAS  PubMed  Google Scholar 

  24. Miwa H, Sasaki M, Furuta T, Koike T, Habu Y, Ito M, et al. Efficacy of rabeprazole on heartburn symptom resolution in patients with non-erosive and erosive gastro-oesophageal reflux disease: a multicenter study from Japan. Aliment Pharmacol Ther. 2007;26(1):69–77.

    Article  CAS  PubMed  Google Scholar 

  25. Fujiwara Y, Higuchi K, Shiba M, Yamamori K, Watanabe Y, Sasaki E, et al. Differences in clinical characteristics between patients with endoscopy-negative reflux disease and erosive esophagitis in Japan. Am J Gastroenterol. 2005;100(4):754–8.

    Article  PubMed  Google Scholar 

  26. Prasad M, Rentz AM, Revicki DA. The impact of treatment for gastro-oesophageal reflux disease on health-related quality of life: a literature review. Pharmacoeconomics. 2003;21(11):769–90.

    Article  PubMed  Google Scholar 

  27. Wiklund I. Quality of life in patients with gastroesophageal reflux disease. Am J Gastroenterol. 2001;96:S46–S53.

    Article  CAS  PubMed  Google Scholar 

  28. Hongo M, Kinoshita Y, Miwa H, Ashida K. The demographic characteristics and health-related quality of life in a large cohort of reflux esophagitis patients in Japan with reference to the effect of lansoprazole: the REQUEST study. J Gastroenterol (in press).

  29. Adachi K, Hashimoto T, Komazawa Y, Adachi K, Hashimoto T, Komazawa Y, et al. Helicobacter pylori infection influences symptomatic response to anti-secretory therapy in patients with GORD—crossover comparative study with famotidine and low-dose lansoprazole. Dig Liver Dis. 2005;37(7):485–90.

    Article  CAS  PubMed  Google Scholar 

  30. Kinoshita Y, Kobayashi T, Kato M, Asahina K, Haruma K, Shimatani T, et al. The pharmacodynamic effect of omeprazole 10 mg and 20 mg once daily in patients with nonerosive reflux disease in Japan. J Gastroenterol. 2006;41(6):554–61.

    Article  CAS  PubMed  Google Scholar 

  31. Ashida K, Hongo M. Pharmacodynamic efficacy of lansoprazole(AG–1749)15 mg and 30 mg in controlling intraesophageal pH in Japanese patients with non-erosive reflux disease as assessed by 24-hour intraesophageal pH monitoring—a randomized, multi-center, double blind trial (in Japanese with English abstract). Jpn Pharmacol Ther. 2008;36(7):641–54.

    CAS  Google Scholar 

  32. Hongo M, Hoshihara Y. Efficacy and safety of lansoprazole(AG–1749)15 mg and 30 mg in Japanese patients with non-erosive reflux disease(NERD)—a phase III multicenter, double-blind, placebo-controlled trial (in Japanese with English abstract). Jpn Pharmacol Ther. 2008;36(7):655–71.

    CAS  Google Scholar 

  33. Dean BB, Gano AD Jr, Knight K, Ofman JJ, Fass R. Effectiveness of proton pump inhibitors in nonerosive reflux disease. Clin Gastroenterol Hepatol. 2004;2(8):656–64.

    Article  CAS  PubMed  Google Scholar 

  34. Galmiche JP, Stephenson K. Treatment of gastroesophageal reflux disease in adults: an individualized approach. Dig Dis. 2004;22(2):148–60.

    Article  PubMed  Google Scholar 

  35. Ang D, Sifrim D, Tack J. Mechanisms of heartburn. Nat Clin Pract Gastroenterol Hepatol. 2008;5(7):383–92.

    Article  CAS  PubMed  Google Scholar 

  36. Hiyama T, Yoshihara M, Tanaka S, Haruma K, Chayama K. Strategy for treatment of nonerosive reflux disease in Asia. World J Gastroenterol. 2008;14(20):3123–8.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Hoshihara Y, Hashimoto M. Endoscopic classification of reflux esophagitis (in Japanese with English abstract). Nippon Rinsho. 2000;58:1808–12.

    CAS  PubMed  Google Scholar 

  38. Hongo M. Minimal changes in reflux esophagitis: red ones and white ones. J Gastroenterol. 2006;41:95–9.

    Article  PubMed  Google Scholar 

  39. Amano Y, Ishimura N, Furuta K, Amano Y, Ishimura N, Furuta K, et al. Interobserver agreement on classifying endoscopic diagnoses of nonerosive esophagitis. Endoscopy. 2006;38(10):1032–5.

    Article  CAS  PubMed  Google Scholar 

  40. Miwa H, Yokoyama T, Hori K, Sakagami T, Oshima T, Tomita T, et al. Interobserver agreement in endoscopic evaluation of reflux esophagitis using a modified Los Angeles classification incorporating grades N and M: a validation study in a cohort of Japanese endoscopists. Dis Esophagus. 2008;21(4):355–6.

    Article  CAS  PubMed  Google Scholar 

  41. Joh T, Miwa H, Higuchi K, Shimatani T, Manabe N, Adachi K, et al. Validity of endoscopic classification of nonerosive reflux disease. J Gastroenterol. 2007;42(6):444–9.

    Article  PubMed  Google Scholar 

  42. Hoshihara Y, Kogure T, Yamamoto T, Hashimoto M, Hoteya O. Endoscopic diagnosis of Barrett’s esophagus (in Japanese with English abstract). Nippon Rinsho. 2005;63(8):1394–8.

    PubMed  Google Scholar 

  43. Ogiya K, Kawano T, Ito E, Nakajima Y, Kawada K, Nishikage T, et al. Lower esophageal palisade vessels and the definition of Barrett’s esophagus. Dis Esophagus. 2008. doi:10.1111/j.1442-2050.2008.00825.

  44. Kawano T, Kouzu T, Ohara S, Kusano M. The prevalence of Barrett’s mucosa in the Japanese (in Japanese with English abstract). Gastroenterol Endosc. 2005;47(4):951–61.

    Google Scholar 

  45. Amano Y, Ishimura N, Furuta K, Takahashi Y, Chinuki D, Mishima Y, et al. Which landmark results in a more consistent diagnosis of Barrett’s esophagus, the gastric folds or the palisade vessels? Gastrointest Endosc. 2006;64(2):206–11.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Hiroto Miwa.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Miwa, H., Oshima, T., Tomita, T. et al. Gastro-esophageal reflux disease: the recent trend in Japan. Clin J Gastroenterol 1, 133–138 (2008). https://doi.org/10.1007/s12328-008-0039-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12328-008-0039-7

Keywords

Navigation