藤本一眞，岡本多代，岩切龍一：胃・食道逆流症．Ⅱ．疫学からみた胃・食道逆流症．日内会誌2000；89：9-13．.
Fujiwara Y, Arakawa T.
Epidemiology and clinical characteristics of GERD in the Japanese population.
J Gastroenterol. 2009;44(6):518-34. doi: 10.1007/s00535-009-0047-5. Epub 2009 Apr 14.
Abstract/Text
We reviewed articles on the epidemiology and clinical characteristics of gastroesophageal reflux disease (GERD) in Japan to clarify these features of GERD in this country. Although the definition of GERD depends on the individual study, the prevalence of GERD has been increasing since the end of the 1990s. The reasons for the increase in the prevalence of GERD may be due to increases in gastric acid secretion, a decrease in the Helicobacter pylori infection rate, more attention being paid to GERD, and advances in the concept of GERD. More than half of GERD patients had non-erosive reflux disease, and the majority (87%) of erosive esophagitis was mild type, such as Los Angeles classification grade A and grade B. There were several identified risk factors, such as older age, obesity, and hiatal hernia. In particular, mild gastric atrophy and absence of H. pylori infection influence the characteristics of GERD in the Japanese population. We also discuss GERD in the elderly; asymptomatic GERD; the natural history of GERD; and associations between GERD and peptic ulcer disease and H. pylori eradication. We examined the prevalence of GERD in patients with specific diseases, and found a higher prevalence of GERD, compared with that in the general population, in patients with diabetes mellitus, those with obstructive sleep apnea syndrome, and those with bronchial asthma. We provide a comprehensive review of GERD in the Japanese population and raise several clinical issues.
Fass R.
Epidemiology and pathophysiology of symptomatic gastroesophageal reflux disease.
Am J Gastroenterol. 2003 Mar;98(3 Suppl):S2-7. doi: 10.1016/s0002-9270(03)00009-1.
Abstract/Text
Symptomatic, or nonerosive, gastroesophageal reflux disease (GERD) is the most common presentation of GERD. Patients with symptomatic GERD more frequently are younger, female, weigh less, and are less likely to have a hiatal hernia compared with patients who have erosive GERD. Physiologically, these patients demonstrate minimal esophageal motor abnormalities. However, despite a common clinical presentation and similar endoscopic findings, symptomatic GERD is comprised of a heterogeneous group of patients. There are several identifiable subgroups differentiated by the underlying mechanisms causing their heartburn symptoms, distinctions that may explain the relatively low symptom response rate to potent antireflux treatment observed among these patients as compared with those with erosive esophagitis.
Iwakiri K, Kawami N, Sano H, Tanaka Y, Umezawa M, Kotoyori M, Hoshihara Y, Sakamoto C.
Mechanisms of excessive esophageal acid exposure in patients with reflux esophagitis.
Dig Dis Sci. 2009 Aug;54(8):1686-92. doi: 10.1007/s10620-008-0542-1. Epub 2008 Nov 13.
Abstract/Text
The pathophysiology of excessive esophageal acid exposure, including the way refluxed acid extends towards the proximal esophagus, in patients with reflux esophagitis (RE), is not yet clear. For 3 h after a meal, concurrent esophageal manometry and pH monitoring was carried out on 14 patients with severe RE, 15 patients with mild RE, and 15 healthy subjects. At 2 cm above the proximal margin of the lower esophageal sphincter (LES) there was no difference between the three groups in the total number of acid-reflux episodes, the rate of transient LES relaxations (TLESRs), or the rate of acid reflux during TLESRs. The rate of acid reflux at 7 cm above the proximal margin of the LES, during TLESRs, in patients with severe RE (50.9%, median) was, however, significantly higher than in patients with mild RE (35.7%) and healthy subjects (15.4%). In addition, the rate of acid reflux during TLESRs in patients with mild RE was significantly higher than in healthy subjects. Both the amplitude and the success rate of primary peristalsis in patients with severe RE were significantly lower than those of healthy subjects and patients with mild RE but there was no difference between healthy subjects and patients with mild RE. The cause of excessive acid exposure in patients with RE is the difference in the way refluxed acid extends towards the proximal esophagus and acid bolus clearance, not the number of acid-reflux episodes.
木下芳一，古田賢司，足立経一：NERD（non-erosive reflux disease）の診断と治療．日消誌2005；102： 1377-1383．.
Fass R, Shapiro M, Dekel R, Sewell J.
Systematic review: proton-pump inhibitor failure in gastro-oesophageal reflux disease--where next?
Aliment Pharmacol Ther. 2005 Jul 15;22(2):79-94. doi: 10.1111/j.1365-2036.2005.02531.x.
Abstract/Text
Proton-pump inhibitor failure has become a common clinical dilemma in gastrointestinal clinics and has been increasingly encountered at the primary care level as well. Underlying mechanisms are diverse and may overlap. Most patients who have proton-pump inhibitor failure are likely to originate from the non-erosive reflux disease phenotype. Currently, available diagnostic modalities provide limited clues to the exact underlying cause. Treatment relies primarily on escalating dosing of proton-pump inhibitors. However, new insights into the pathophysiology of proton-pump inhibitor failure are likely to provide alternative therapeutic options.
Fass R.
Persistent heartburn in a patient on proton-pump inhibitor.
Clin Gastroenterol Hepatol. 2008 Apr;6(4):393-400. doi: 10.1016/j.cgh.2008.02.016.
Abstract/Text
岩切勝彦，佐野弘仁，川見典之，他：食道pH・多チャンネルインピーダンスモニタリングによるPPI抵抗性NERD患者の解析．日消誌2010；107：538-548．.
Dimenäs E.
Methodological aspects of evaluation of Quality of Life in upper gastrointestinal diseases.
Scand J Gastroenterol Suppl. 1993;199:18-21.
Abstract/Text
There is a growing interest in including Quality of Life (QOL) in gastroenterology. Along with objective variables such as healing rate, as recorded with endoscopy, QOL may give a better basis for evaluating medical treatment regimens. However, although QOL is an important aspect to consider, few studies in patients with upper gastrointestinal diseases have evaluated these aspects. The methods for assessing QOL may offer improved possibilities with which to evaluate the impact of therapies but also raise a number of questions concerning how to select, utilize and interpret the results obtained. This work is aimed at exploring some of the possibilities, but also challenges, in the evaluation of Quality of Life in patients with upper gastrointestinal diagnosis.
日本消化器病学会編：胃食道逆流症（GERD）診療ガイドライン2021（改訂第3版）、南江堂、2021年.
星原芳雄：内視鏡診断と分類．常岡健二監修．GERD の診断と治療―GERD の臨床と今日的意義．メディカルレビュー社.
Dean BB, Gano AD Jr, Knight K, Ofman JJ, Fass R.
Effectiveness of proton pump inhibitors in nonerosive reflux disease.
Clin Gastroenterol Hepatol. 2004 Aug;2(8):656-64. doi: 10.1016/s1542-3565(04)00288-5.
Abstract/Text
BACKGROUND & AIMS: Little information is available about the efficacy of proton pump inhibitors (PPIs) in patients with nonerosive reflux disease (NERD). We aimed to synthesize available data and determine the effectiveness of PPIs on symptom resolution in patients with NERD.
METHODS: A systematic review of the literature identified studies reporting the effects of PPIs in patients with NERD. Heartburn resolution data were pooled across studies. The effectiveness of PPI therapy in inducing complete heartburn resolution was compared in patients with NERD vs. erosive esophagitis (EE).
RESULTS: Seven trials evaluating heartburn resolution in NERD were identified. Higher proportions of patients reported achieving sufficient heartburn resolution compared with complete heartburn resolution. The effect of PPIs on sufficient heartburn resolution was observed sooner than was complete heartburn resolution. Therapeutic gain of PPI therapy over placebo ranged from 30% to 35% for sufficient heartburn control and from 25% to 30% for complete heartburn control. Pooled response rates at 4 weeks were significantly higher for patients with EE compared with NERD (56% vs. 37%, P < 0.0001).
CONCLUSIONS: PPIs provide a more modest therapeutic gain in patients with NERD as compared with those with EE. A trend in increased therapeutic gain for NERD patients was shown throughout the 4 weeks, suggesting that 4 weeks of follow-up evaluation may be insufficient to show full therapeutic gain in this patient population.
Fass R.
Gastroesophageal Reflux Disease.
N Engl J Med. 2022 Sep 29;387(13):1207-1216. doi: 10.1056/NEJMcp2114026.
Abstract/Text
