Evidence-based clinical practice guidelines for gastroesophageal reflux disease 2021

J Gastroenterol. 2022 Apr;57(4):267-285. doi: 10.1007/s00535-022-01861-z. Epub 2022 Feb 28.


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.

Keywords: 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.

Publication types

  • Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Esophagitis, Peptic* / diagnosis
  • Esophagitis, Peptic* / drug therapy
  • Evidence-Based Practice
  • Gastroenterology*
  • Gastroesophageal Reflux* / diagnosis
  • Gastroesophageal Reflux* / drug therapy
  • Humans
  • Proton Pump Inhibitors / therapeutic use


  • Proton Pump Inhibitors