胃食道逆流症に対する内視鏡診断と治療の現状と課題

Gastroesophageal reflux disease (GERD) is classified into “reflux esophagitis,” characterized by esophageal mucosal break, and “non-erosive reflux disease (NERD),” characterized by the presence of only GERD symptoms without mucosal injury. The revised Los Angeles classification, which adds minimal change, is widely used in Japan for the endoscopic diagnosis of reflux esophagitis. The main treatment for GERD is pharmacotherapy, and proton pump inhibitors are the first-line drugs. Vonoprazan, a potassium-competitive acid blocker, is highly effective in the treatment of severe reflux esophagitis. Endoscopic treatment of GERD is not widely used in Japan. However, from April 2022, endoscopic treatment reported as anti-reflux mucosectomy (ARMS) and endoscopic submucosal dissection for GERD (ESD-G) have been covered by health insurance as endoscopic anti-reflux mucosectomy. Therefore, it is expected that endoscopic treatment for GERD will become more widespread in Japan. Moreover, it is necessary to clarify the indications and long-term prognosis of this treatment in the future.