title: Gastroesophageal Reflux Disease in Time Covering Eradication for All Patients Infected with Helicobacter pylori in Japan.
abstract: BACKGROUND
  The prevalence of gastroesophageal reflux disease (GERD) has increased in Japan since the end of the 20th century due to changes in environmental factors, such as a decreased infection rate of Helicobacter pylori and increased ability of acid secretion in the Japanese population. In 2013, the Japanese health insurance system started to cover eradication treatment for all patients infected with H. pylori to prevent gastric cancer, suggesting we may soon be able to completely eradicate this infection in Japan. Re-clarification of the clinical characteristics of GERD in Japan is therefore required in time covering the eradication for all patients infected with H. pylori.
  
  
  CONCLUSIONS
  In Japan, more than half of GERD patients exhibit non-erosive reflux disease, and a majority of erosive esophagitis (RE) cases have mild severity of GERD (Los Angeles classification of grades A and B). The prevalence of RE in H. pylori-positive patients is relatively low (4.1%) compared to the general Japanese population (7.6-10.6%). In multivariate analysis to evaluate a risk of RE development, a risk in H. pylori-positive patients is elevated in those with mild gastric mucosal atrophy (C-I and C-II according to the Kimura-Takemoto classification, OR 12.14, 95% CI 1.28-115.26, p = 0.03) or with hiatal hernia (OR 5.24, 95% CI 1.80-15.22, p < 0.01). Here, we provide a comprehensive review of GERD in Japan, including associations between GERD and H. pylori infection, low-dose-aspirin-induced GERD, and pharmacological treatment for GERD.
  
  
  CONCLUSIONS
  The recent decrease in the rate of H. pylori infection and increase in the proportion of elderly persons might have increased the prevalence of GERD in Japan.
authors.affiliation: Division of Digestive Endoscopy, Shiga University of Medical Science Hospital, Shiga, Japan.
authors.forename: Mitsushige
authors.initials: M
authors.lastname: Sugimoto
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uotani
authors.forename: Hitomi
authors.initials: H
authors.lastname: Ichikawa
authors.forename: Akira
authors.initials: A
authors.lastname: Andoh
authors.forename: Takahisa
authors.initials: T
authors.lastname: Furuta
mesh_terms: D000367:Age Factors; D000368:Aged; D001471:Barrett Esophagus / Q000453:epidemiology; D004942:Esophagitis, Peptic / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D005260:Female; D005753:Gastric Mucosa / Q000473:pathology*; D005764:Gastroesophageal Reflux / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D016481:Helicobacter Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D016480:Helicobacter pylori; D006551:Hernia, Hiatal / Q000453:epidemiology; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010437:Peptic Ulcer / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D012737:Sex Factors