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Iwakiri K, Kinoshita Y, Habu Y, Oshima T, Manabe N, Fujiwara Y, Nagahara A, Kawamura O, Iwakiri R, Ozawa S, Ashida K, Ohara S, Kashiwagi H, Adachi K, Higuchi K, Miwa H, Fujimoto K, Kusano M, Hoshihara Y, Kawano T, Haruma K, Hongo M, Sugano K, Watanabe M, Shimosegawa T. Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2015. J Gastroenterol 2016; 51:751-67. [PMID: 27325300 DOI: 10.1007/s00535-016-1227-8] [Citation(s) in RCA: 181] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Accepted: 05/17/2016] [Indexed: 02/04/2023]
Abstract
As an increase in gastroesophageal reflux disease (GERD) has been reported in Japan, and public interest in GERD has been increasing, the Japanese Society of Gastroenterology published the Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009. Six years have passed since its publication, and there have been a large number of reports in Japan concerning the epidemiology, pathophysiology, treatment, and Barrett's esophagus during this period. By incorporating the contents of these reports, the guidelines were completely revised, and a new edition was published in October 2015. The revised edition consists of eight items: epidemiology, pathophysiology, diagnosis, internal treatment, surgical treatment, esophagitis after surgery of the upper gastrointestinal tract, extraesophageal symptoms, and Barrett's esophagus. This paper summarizes these guidelines, particularly the parts related to the treatment for GERD. In the present revision, aggressive proton pump inhibitor (PPI) maintenance therapy is recommended for severe erosive GERD, and on-demand therapy or continuous maintenance therapy is recommended for mild erosive GERD or PPI-responsive non-erosive GERD. Moreover, PPI-resistant GERD (insufficient symptomatic improvement and/or esophageal mucosal break persisting despite the administration of PPI at a standard dose for 8 weeks) is defined, and a standard-dose PPI twice a day, change in PPI, change in the PPI timing of dosing, addition of a prokinetic drug, addition of rikkunshito (traditional Japanese herbal medicine), and addition of histamine H2-receptor antagonist are recommended for its treatment. If no improvement is observed even after these treatments, pathophysiological evaluation with esophageal impedance-pH monitoring or esophageal manometry at an expert facility for diseases of the esophagus is recommended.
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Affiliation(s)
- Katsuhiko Iwakiri
- Department of Gastroenterology, Nippon Medical School Graduate School of Medicine, Sendagi 1-1-5, Bunkyo-ku, Tokyo, 113-8603, Japan. .,Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan.
| | - Yoshikazu Kinoshita
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yasuki Habu
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Tadayuki Oshima
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Noriaki Manabe
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yasuhiro Fujiwara
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Akihito Nagahara
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Osamu Kawamura
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Ryuichi Iwakiri
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Soji Ozawa
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Kiyoshi Ashida
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Shuichi Ohara
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hideyuki Kashiwagi
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Kyoichi Adachi
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Kazuhide Higuchi
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Hiroto Miwa
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Kazuma Fujimoto
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Motoyasu Kusano
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Yoshio Hoshihara
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Tatsuyuki Kawano
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Ken Haruma
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Michio Hongo
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Kentaro Sugano
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Mamoru Watanabe
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
| | - Tooru Shimosegawa
- Guidelines Committee for Creating and Evaluating the "Evidence-based Clinical Practice Guidelines for Gastroesophageal Reflux Disease", the Japanese Society of Gastroenterology (JSGE), K-18 Building 8F, 8-9-13, Ginza, Chuo, Tokyo, 104-0061, Japan
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von Renteln D, Schiefke I, Fuchs KH, Raczynski S, Philipper M, Breithaupt W, Caca K, Neuhaus H. Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease using multiple Plicator implants: 12-month multicenter study results. Surg Endosc 2009; 23:1866-75. [PMID: 19440792 DOI: 10.1007/s00464-009-0490-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2008] [Revised: 02/23/2009] [Accepted: 03/25/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND The full-thickness Plicator (Ethicon Endosurgery, Sommerville, NJ, USA) was developed for endoscopic treatment of gastroesophageal reflux disease (GERD). The goal is to restructure the antireflux barrier by delivering transmural pledgeted sutures through the gastric cardia. To date, studies using this device have involved the placement of a single suture to create the plication. The purpose of this study was to evaluate the 12-month safety and efficacy of this procedure using multiple implants to restructure the gastroesophageal (GE) junction. METHODS A multicenter, prospective, open-label trial was conducted at four tertiary centers. Eligibility criteria included symptomatic GERD [GERD Health-Related Quality-of-Life (GERD-HRQL) questionnaire, off of medication], and pathologic reflux (abnormal 24-h pH) requiring daily proton pump inhibitor therapy. Patients with Barrett's epithelium, esophageal dysmotility, hiatal hernia > 3 cm, and esophagitis (grade III or greater) were excluded. All patients underwent endoscopic full-thickness plication with linear placement of at least two transmural pledgeted sutures in the anterior gastric cardia. RESULTS Forty-one patients were treated. Twelve months post treatment, 74% of patients demonstrated improvement in GERD-HRQL scores by > or = 50%, with mean decrease of 17.6 points compared with baseline (7.8 vs. 25.4, p < 0.001). Using an intention-to-treat model, 63% of patients had symptomatic improvements of > or = 50%, with mean GERD-HRQL decrease of 15.0 (11.0 vs. 26.0, p < 0.001). The need for daily proton pump inhibitor (PPI) therapy was eliminated in 69% of patients at 12 months on a per-protocol basis, and 59% on an intention-to-treat basis. Adverse events included postprocedure abdominal pain (44%), shoulder pain (24%), and chest pain (17%). No long-term adverse events occurred. CONCLUSIONS Endoscopic full-thickness plication using multiple Plicator implants can be used safely and effectively to improve GERD symptoms and reduce medication use.
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Affiliation(s)
- D von Renteln
- Department of Gastroenterology, Hepatology and Oncology, Klinikum Ludwigsburg, Teaching Hospital of the Heidelberg University, Ludwigsburg, Germany.
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