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[Acid-suppressive strategy against gastroesophageal reflux diseases and non-erosive reflux diseases: the alternative of proton- pump inhibitors or H2 receptor antagonists].

Gastroesophageal reflux disease (GERD) is categorized into three distinct entities: erosive reflux diseases(ERD), non -erosive reflux diseases(NERD) and Barrett's esophagus. In ERD, early symptomatic relief as well as healing of the esophageal mucosal injury to prevent complications is the goal of the treatment, whereas in NERD, alleviation of the symptoms leading to better quality of life is the main goal. According to the results of randomized controlled trials comparing proton-pump inhibitors (PPIs) with H2-receptor antagonists (H2RAs) head-to-head, PPIs are superior to H2RAs in the treatment for ERD. However, H2RA was equally effective with PPI to the Japanese ERD patients with low-grade esophageal mucosal breaks and positive Helicobacter pylori (H. pylori) infection. PPIs are also more beneficial than H2RAs in NERD in Western literatures but overall therapeutic gains of PPIs in NERD are lower than those reported in ERD, indicating heterogeneity of NERD pathophysiology. Again, H2RA was reported to show equal effectiveness with PPI in NERD patients with positive H. pylori status in Japan. Thus, on -demand treatment with H2RA in NERD patients with positive H. pylori status could be an alternative option. In conclusion, optimal management of the Japanese GERD patients with acid suppressive therapies should be tailored to individual conditions.