Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021

Katsuhiko Iwakiri, Yasuhiro Fujiwara, Noriaki Manabe, Eikichi Ihara, Shiko Kuribayashi, Junichi Akiyama, Takashi Kondo, Hiroshi Yamashita, Norihisa Ishimura, Yuichi Kitasako, Katsunori Iijima, Tomoyuki Koike, Nobuo Omura, Tsutomu Nomura, Osamu Kawamura, Shuichi Ohara, Soji Ozawa, Yoshikazu Kinoshita, Satoshi Mochida, Nobuyuki EnomotoTooru Shimosegawa, Kazuhiko Koike

Research output: Contribution to journalReview articlepeer-review

44 Citations (Scopus)


In Japan, with the increasing prevalence of gastroesophageal reflux disease (GERD) and growing public interest, the Japanese Society of Gastroenterology issued Evidence-based Clinical Practice Guidelines for GERD (1st edition) in 2009 and a revised 2nd edition in 2015. A number of studies on GERD were subsequently conducted in Japan and abroad, and vonoprazan, a potassium-competitive acid blocker (P-CAB), became available for the first time in Japan in February 2015. The revised 3rd edition (Japanese edition), which incorporates new findings and information, was published in April 2021. These guidelines are summarized herein, particularly sections related to the treatment of GERD. The important clinical issues addressed in the present revision are (i) the introduction of treatment algorithms that classify GERD into reflux esophagitis and non-erosive reflux disease, (ii) the clarification of treatment algorithms based on to the severity of reflux esophagitis, and (iii) the positioning of vonoprazan in the treatment for GERD. The present guidelines propose vonoprazan as the initial/maintenance treatment for severe reflux esophagitis. They also recommend vonoprazan or PPI as an initial treatment for mild reflux esophagitis and recommended PPI and proposed vonoprazan as maintenance treatment. These updated guidelines offer the best clinical strategies for GERD patients in Japan and hope that they will be of global use for the diagnosis and treatment for GERD.

Original languageEnglish
Pages (from-to)267-285
Number of pages19
JournalJournal of Gastroenterology
Issue number4
Publication statusPublished - 2022 Apr


  • Algorithm
  • Gastroesophageal reflux disease (GERD)
  • Guidelines
  • Heartburn
  • Japanese traditional medicine
  • Non-erosive reflux disease
  • Potassium-competitive acid blocker (P-CAB)
  • Prokinetic drug
  • Proton pump inhibitor
  • Reflux esophagitis
  • Vonoprazan


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