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    Home > Active Ingredient News > Digestive System Information > 5 flowcharts to guide you through the Japanese guidelines for the diagnosis and treatment of gastroesophageal reflux disease

    5 flowcharts to guide you through the Japanese guidelines for the diagnosis and treatment of gastroesophageal reflux disease

    • Last Update: 2022-04-28
    • Source: Internet
    • Author: User
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    Only for medical professionals to read the reference article summary, guideline update points! In 2021, the Japanese Society of Gastroenterology updated the third edition of the evidence-based clinical practice guidelines for gastroesophageal reflux disease (GERD) [1]
    .

    The English version published this time mainly focuses on the treatment part of the 2021 Japanese GERD Evidence-Based Clinical Practice Guidelines
    .

    It includes a brief summary of each section of the guideline, "recommendations" and "comments" on clinical questions (CQs) related to diagnosis and treatment, and "statements" and "comments" on future research questions (FRQs)
    .

    In addition, the guideline aims to provide guidance for the practice of GERD diagnosis and treatment worldwide by introducing the diagnosis and treatment pathways of GERD
    .

    This article focuses on the diagnosis and treatment path of GERD, in order to provide reference for the clinical treatment of GERD in China
    .

    Red arrow in the flow chart below: judged negative or unsuccessful treatment; blue arrow: judged positive or successful; *prokinetic or Japanese herbal medicine; **10 mg vonoprazane was used in well-controlled cases with the lowest dose Proton pump inhibitors (PPIs); ***Can be treated with minimal doses of PPIs or as needed
    .

    Pathways to endoscopic diagnosis of GERD When GERD is suspected based on clinical assessment, the guidelines propose two paths: (i) endoscopy first before dosing, and (ii) no endoscopy at the start of dosing
    .

    In initial cases undergoing endoscopy, GERD was subdivided into severe reflux esophagitis (RE) (LA grade C or D), mild RE (LA grade A or B), non-erosive reflux Epidemic disease (NERD) and other diseases
    .

    Figure a.
    The endoscopic diagnosis process of GERD (click to enlarge the image) The treatment pathway guideline for severe RE recommends 20 mg potassium ion-competitive acid blocker (P-CAB) Vonolaxine fumarate tablets (hereinafter referred to as Vonolaxine) , VPZ) as the initial treatment regimen for severe RE for 4 weeks
    .

    Other treatments include life>
    .

    Aggressive maintenance therapy with vonoprazol is required for patients who respond to vonoprazol
    .

    Furthermore, combination therapy was defined as the combined therapy of P-CAB with prokinetic or Japanese herbal medicines to prevent the development of complications
    .

    If vonoprazol 10 mg/day maintenance therapy can maintain mucosal healing and good symptom control, it may also be changed to minimal-dose PPI maintenance therapy
    .

    In addition, anti-reflux surgery also needs to be considered
    .

    In the case of ineffectiveness of initial treatment, vornoxan 20 mg/day can be continued for 8 weeks or combined therapy can be started
    .

    Figure b Treatment of severe RE (click to enlarge) Treatment pathway for mild RE The guidelines recommend standard doses of PPI or 20 mg of vonoprazol as initial treatment options for mild RE
    .

    Lowest-dose PPI or P-CAB therapy (including as-needed therapy), or combination therapy may be an option for maintenance therapy
    .

    In addition, anti-reflux surgery also needs to be considered
    .

    For the treatment of PPI-resistant mild RE, the guidelines recommend the use of double-dose PPI or 20 mg of vonoprazan
    .

    Figure c Treatment of mild RE (click to enlarge) Guidelines for the treatment of NERD recommend PPIs as the initial treatment for NERD for 4 weeks, with the lowest doses of PPIs (including as-needed therapy) or a combination regimen for maintenance therapy.
    Improve symptoms
    .

    Figure d Treatment of NERD (click to enlarge) GERD without endoscopic diagnostic pathway PPI testing can be applied to non-endoscopy cases
    .

    Treatment can be discontinued if symptoms are relieved by PPI prior to endoscopy and these symptoms are transient
    .

    If symptoms persist or recur, endoscopy is required
    .

    Panel e GERD without endoscopic treatment (click to enlarge image) Treatment of refractory cases for P-CAB-resistant RE (panels b, c), mild RE resistant to double-dose PPI (panel c), or PPI-resistant NERD (Panel d), pathophysiological assessment with multi-channel transluminal esophageal impedance-pH monitoring and/or esophageal manometry is recommended to examine the relationship between symptoms and esophageal pathophysiology or acid suppression status
    .

    If gastroesophageal reflux is confirmed to be related to symptoms, or if acid suppression remains insufficient after P-CAB therapy in patients with severe RE, further professional guidance or surgical treatment may be considered
    .

    Reference: [1] Iwakiri K, et al.
    2021.
    J Gastroenterol.
    Published online: 28 Feb 2022.
    Approval number: VV-MEDMAT-64683 Approval date: March 23, 2022 Expiration date: March 23, 2024 Review of Past Issues: New Research Progress | The pathogenic factors of esophageal squamous cell carcinoma in the past may have overlooked the confusion about GERD diagnosis and treatment of GERD.
    "Mucosal healing" is the real victory! | Anti-G War (4) In the face of difficult reflux esophagitis, read "On Protracted War" | Anti-G War (3) The sharp edge of the game, the attacking soldiers, who are they? | The War Against G (2) GERD - a strong fortress, a stalemate war
    |
    Such information is not intended to replace professional medical advice in any way and should not be considered medical advice
    .

    If such information is used for purposes other than information understanding, this site and Takeda shall not be held responsible
    .

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