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.

/pdf/epidemiology-and-clinical-characteristics-of-gerd-in-the-3115osikmh.pdf

Epidemiology and clinical characteristics of GERD in the Japanese population.

#### Summary points

Hiatus hernia is a condition involving herniation of the contents of the abdominal cavity, most commonly the stomach, through the diaphragm into the mediastinum. In the United States, hiatus hernia was listed as a primary or secondary cause of hospital admissions in 142 of 10 000 inpatients between 2003 and 2006.1 However, the exact prevalence of hiatus hernia is difficult to determine because of the inherent subjectivity in diagnostic criteria. Consequently, estimates vary widely—for example, from 10% to 80% of the adult population in North America.2 It is, however, accepted that the prevalence of hiatus hernia parallels that of obesity and that it increases with age. The typical symptom of hiatus hernia is gastroesophageal reflux (heartburn, regurgitation). Less common symptoms are dysphagia, epigastric or chest pain, and chronic iron deficiency anaemia. This clinical review summarises the current evidence for the diagnosis and management of hiatus hernia.

#### Sources and selection criteria

We based this review on articles identified through a search of PubMed using the term “hiatal hernia” on 12 August 2014. Largely because of the extensive literature on reflux disease and the overlap between reflux disease and hiatus hernia, the search returned over 4500 citations, even when limited to publications in the English …

https://www.bmj.com/content/bmj/349/bmj.g6154.full.pdf

The diagnosis and management of hiatus hernia

The prevalence of gastroesophageal reflux disease (GERD) ranges from 2.5% to 7.1% in most population-based studies in Asia. There is evidence that GERD and its complications are rising, coinciding with a decline in Helicobacter pylori (H. pylori) infection. Asian GERD patients share similar risk factors and pathophysiological mechanisms with their Western counterparts. Possible causes for the lower prevalence of GERD include less obesity and hiatus hernia, a lesser degree of esophageal dysmotility, a high prevalence of virulent strains of H. pylori, and low awareness. Owing to the lack of precise translation for ‘heartburn’ in most Asian languages, reflux symptoms are often overlooked or misinterpreted as dyspepsia or chest pain. Furthermore, a symptom-based diagnosis with a therapeutic trial of the proton pump inhibitor (PPI) may be hampered by the high prevalence of H. pylori-related disease. The risk stratification for prompt endoscopy, use of a locally-validated, diagnostic symptom questionnaire, and response to H. pylori‘test and treat’ help improve the accuracy of the PPI test for diagnoses. PPI remain the gold standard treatment, and ‘on-demand’ PPI have been shown to be a cost-effective, long-term treatment. The clinical course of GERD is benign in most patients in Asia. The risk of progression from non-erosive reflux disease to erosive esophagitis is low, and treatment response to a conventional dose of PPI is generally higher. Although H. pylori eradication may lead to more resilient GERD in a subset of patients, the benefits of H. pylori eradication outweigh the risks, especially in Asian populations with a high incidence of gastric cancer.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1440-1746.2008.05684.x

Gastroesophageal reflux disease: An Asian perspective

Objective
The objectives of this study was to clarify the relationship between kyphosis and Gastroesophageal reflux disease (GERD) by evaluation of spinal alignment, obesity, osteoporosis, back muscle strength, intake of oral drugs, and smoking and alcohol history in screening of a community population to determine the factors related to GERD symptoms.

/pdf/influence-of-lumbar-kyphosis-and-back-muscle-strength-on-the-24dux61tsw.pdf

Influence of lumbar kyphosis and back muscle strength on the symptoms of gastroesophageal reflux disease in middle-aged and elderly people

Background and Aims:  Asymptomatic erosive esophagitis (AEE) is an easily forgotten subgroup of gastroesophageal reflux disease due to its lack of warning symptoms, despite having the risk of developing complications, such as bleeding, stricture, or even esophageal adenocarcinoma



Methods:  A total of 2843 potentially eligible patients were screened at the health management center of Buddhist Tzu Chi General Hospital A total of 1001 patients responded to the survey and gave informed consent; 998 patients who completed the reflux disease diagnostic questionnaire were enrolled Of them, 594 patients who had no reflux symptoms were included for final analysis The presence and severity of erosive esophagitis was graded according to the Los Angeles classification Active infection of Helicobacter pylori (H pylori) was determined by the Campylo-like organism (CLO) test during endoscopies



Results:  A total of 145% (86/594) of asymptomatic patients had endoscopic findings of erosive esophagitis In the univariate analysis, male sex and hiatus hernia were significantly associated with AEE Positive CLO tests had a trend association Based on the multivariate analysis, male sex (odds ratio [OR]: 232, 95% confidence interval [CI]: 135–398), hiatus hernia (OR: 448, 95% CI: 235–8917), and positive CLO test (OR: 057, 95% CI: 034–095) were associated with AEE, as compared to the healthy controls



Conclusions:  AEE is not a rare condition, and constitutes 145% of the asymptomatic population Male sex, hiatus hernia, and H pylori infection are factors associated with AEE These findings are not only helpful in identifying such asymptomatic patients, but also provide information to improve understanding of the relationship between H pylori infection, reflux symptoms, and erosive esophagitis

Male sex, hiatus hernia, and Helicobacter pylori infection associated with asymptomatic erosive esophagitis

Background. In Europe and the United States, it is known that obesity, which is increasing, is closely associated with gastroesophageal reflux disease (GERD), but in Japan no definite consensus has been reached on this relationship. Clarification of the relationship between the two is an important issue. Methods. After screening, gastrointestinal endoscopic examinations were conducted on 1813 subjects who were surveyed using a questionnaire in which they recorded body weight, height, weight loss or gain, chief complaints, and underlying disease to prospectively examine the relationship between obesity and GERD. Differences in GERD prevalence and esophageal hiatal hernia prevalence in thin (body mass index less than 18.5 kg/m2), normal (18.5 to 25.0), and obese (greater than 25.0) subjects were examined, and the differences in GERD prevalence in patients with weight loss or gain were also investigated. Results. GERD prevalence was 20.96% in the thin group, 24.42% in the normal group, and 31.86% in the obese group, indicating a significantly higher prevalence in the obese group compared with the other groups. The prevalence of hernia was also significantly higher in the obese group. GERD prevalence in the weight gain group was significantly higher than in the unchanged weight group and weight loss group. Conclusions. Both GERD prevalence and the prevalence of hernia were significantly higher in obese subjects, and the prevalence of GERD in subjects who had gained weight was also significantly higher. From these results, it was concluded that obesity is a risk factor for GERD in Japan.

Obesity as a risk factor for GERD in Japan.

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Obesity as a risk factor for GERD in Japan.