Trends in proton pump inhibitor use, reflux esophagitis, and various upper gastrointestinal symptoms from 2010 to 2019 in Japan

Abstract

The increasing usage of proton pump inhibitors (PPIs) has been reported worldwide, but information on PPI use in East Asia is inadequate. This study aimed to examine the trends in PPI use in Japan, along with the changes in histamine H2 receptor antagonist (H2RA) use, disease rate of reflux esophagitis, and the prevalence of upper gastrointestinal symptoms. We analyzed 217,712 healthy subjects (127,607 men and 90,105 women; 51.4 ± 9.7 years old) participating in the health check program from 2010 to 2019. Various upper gastrointestinal symptoms were evaluated using the frequency scale for the symptoms of gastroesophageal reflux disease (FSSG) questionnaire. Reflux esophagitis was diagnosed by esophageal erosion using the Los Angeles classification grades A, B, C, and D. From 2010 to 2019, the percentage of PPI users increased markedly from approximately 1.8% to 5.3%, whereas that of H2RA users decreased gradually from approximately 2.5% to 1.9%. The use of all classical types of PPIs (omeprazole, lansoprazole, rabeprazole, and esomerazole) and a new type of PPI, a potassium-competitive acid blocker (vonoprazan), greatly increased during the 10 years. An upward trend in the prevalence of reflux esophagitis was observed from 2010 to 2015, but not from 2016 to 2019, indicating that the monotonic rising prevalence of reflux disease stopped in the middle of the 2010s in Japan. In contrast, various upper gastrointestinal symptoms significantly improved between 2010 and 2019. All 12 FSSG symptoms of PPI users were significantly worse than those of non-PPI users, suggesting that PPIs still cannot completely control upper gastrointestinal symptoms. In conclusion, this study revealed a significant increase in PPI use and a slight decrease in H2RA use from 2010 to 2019. Despite a plateau in the prevalence of reflux esophagitis and considerable improvement in various upper gastrointestinal symptoms, PPI use has continued to increase in Japan.

Proton pump inhibitors are not associated with fundic gland polyps – a systematic review that takes into consideration all known confounders

“…The past two decades have witnessed a dramatic rise in the use of proton pump inhibitors (PPIs), with an increase of five-fold [ 1 ] and ten-fold [ 2 ] in China, 2.8-fold in Japan [ 3 ], two-fold in USA [ 4 ] and UK [ 5 ] and Iceland [ 6 ], 65% increase in Spain [ 7 ] and 20% in France [ 8 ]. In 2023, there were 28 million PPI prescription users (over the counter users not known) in 23 countries; 25% used PPI for at least 1 year; use was mainly for dyspepsia and gastroesophageal reflux disease and for prophylaxis against adverse effects of drugs such as aspirin and NSAID [ 9 ].…”

Associations of the timing of sleep and meals with the presence of gastroesophageal reflux disease in community‐dwelling women in Japan

“…1 In Japan, the prevalence of GERD based on the Frequency Scale for the Symptoms of GERD (FSSG) questionnaire 2 was estimated to be 15.5% in 2019 among healthy subjects participating in the health check program. 3 In recent years, it has been suspected that circadian rhythms may play a part in the pathogenesis of gastrointestinal diseases such as irritable bowel syndrome, GERD and peptic ulcers. [4][5][6] Evidence has been accumulated that a broad range of parameters of gastrointestinal functions, such as esophageal or gut motility, saliva production, digestive enzyme expression and so forth, are controlled by circadian regulation.…”

“…Gastroesophageal reflux disease (GERD) is a very common gastrointestinal disorder worldwide, with the typical symptoms of heartburn and regurgitation 1 . In Japan, the prevalence of GERD based on the Frequency Scale for the Symptoms of GERD (FSSG) questionnaire 2 was estimated to be 15.5% in 2019 among healthy subjects participating in the health check program 3 . In recent years, it has been suspected that circadian rhythms may play a part in the pathogenesis of gastrointestinal diseases such as irritable bowel syndrome, GERD and peptic ulcers 4–6 .…”

Appropriateness of proton pump inhibitor therapy in an ambulatory geriatrics clinic: A retrospective cross-sectional analysis

“…The use of proton pump inhibitors (PPIs) has increased worldwide over the past several decades, with a greater increase in older adults compared to younger populations. 1-7 In Canada, the use of PPIs by older adults increased from 26.7% in 2011 to 29.1% in 2016, the majority of which included long-term treatment. 8,9 Long-term PPI therapy, defined as treatment greater than 8 weeks in duration, is indicated for clinically significant erosive esophagitis and related conditions (i.e., Barrett’s esophagus, Zollinger-Ellison syndrome), those with complications of gastroesophageal reflux disease (GERD) (i.e., esophageal strictures) and gastroprotection for long-term users of nonsteroidal anti-inflammatory drugs (NSAIDs) who are at high risk of gastrointestinal (GI) bleeding.…”