Review
Copyright ©2008 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. May 28, 2008; 14(20): 3123-3128
Published online May 28, 2008. doi: 10.3748/wjg.14.3123
Strategy for treatment of nonerosive reflux disease in Asia
Toru Hiyama, Masaharu Yoshihara, Shinji Tanaka, Ken Haruma, Kazuaki Chayama
Toru Hiyama, Masaharu Yoshihara, Health Service Center, Hiroshima University, Higashihiroshima 739-8521, Japan
Shinji Tanaka, Department of Endoscopy, Hiroshima University Hospital, Hiroshima 734-8551, Japan
Ken Haruma, Division of Gastroenterology, Department of Internal Medicine, Kawasaki Medical School, Kurashiki 701-0192, Japan
Kazuaki Chayama, Department of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima 734-8551, Japan
Author contributions: Hiyama T, Yoshihara M and Tanaka S analyzed data; Hiyama T wrote the paper; Haruma K and Chayama K supervised this review.
Correspondence to: Toru Hiyama, MD, PhD, Health Service Center, Hiroshima University, 1-7-1 Kagamiyama, Higashihiroshima 739-8521, Japan. tohiyama@hiroshima-u.ac.jp
Telephone: +81-82-4246191
Fax: +81-82-4227156
Received: February 25, 2008
Revised: April 1, 2008
Accepted: April 8, 2008
Published online: May 28, 2008
Abstract

The paper is to review the clinical and pathophysiologic differences between of nonerosive reflux disease (NERD) and reflux esophagitis (RE), and to propose a treatment strategy for NERD, especially for patients in Asia. A Medline search was performed regarding the clinical and pathophysiologic differences between NERD and RE, and treatment of NERD and RE. The characteristics of NERD patients in Asia are as follows: (1) high proportion of female patients, (2) low frequency of hiatal hernia, (3) high frequency of H pylori infection, (4) severe glandular atrophy of the gastric mucosa, and (5) frequent resistance to proton pump inhibitor (PPI) therapy. In Asian NERD patients, exposure of the esophagus to acid is not increased, and esophageal motility is normal. These characteristics are similar to those of patients in Western countries. Our recommended first-choice treatment is administration of PPI in combination with a prokinetic agent. However, at present, because there is limited evidence regarding effective treatments for NERD, it is best to try several different treatment strategies to find the best treatment for each patient.

Keywords: Nonerosive reflux disease; Asia; Treatment