Journal of Gastroenterology

, Volume 54, Issue 11, pp 972–983 | Cite as

Efficacy and safety of hangeshashinto for treatment of GERD refractory to proton pump inhibitors

Usual dose proton pump inhibitors plus hangeshashinto versus double-dose proton pump inhibitors: randomized, multicenter open label exploratory study
  • Toshihisa TakeuchiEmail author
  • Hitoshi Hongo
  • Tsuguhiro Kimura
  • Yuichi Kojima
  • Satoshi Harada
  • Kazuhiro Ota
  • Nozomi Takeuchi
  • Takao Noguchi
  • Takuya Inoue
  • Mitsuyuki Murano
  • Kazuhide Higuchi
Original Article—Alimentary Tract



Proton pump inhibitor (PPI)-refractory gastroesophageal reflux disease (GERD) leads to a clinical decline in the quality of life (QOL). Therefore, new treatment options are needed. We performed a multicenter, randomized, parallel-group exploratory trial to determine the efficacy of hangeshashinto (HST) in patients with PPI-refractory GERD.


We enrolled 78 patients with PPI-refractory GERD for standard PPI regimens for at least 4 weeks and randomly assigned patients to receive either a combination of usual dose of rabeprazole (10 mg/day) + HST (7.5 g/day; HST group) or a double dose of rabeprazole (20 mg/day; double-dose PPI group). The primary end points were the extent of improvement in FSSG (Frequency Scale for the Symptoms of GERD) score and the change over time in FSSG score.


There was no significant difference in terms of the improvement degree of the FSSG score between the two groups. Although the total FSSG score and reflux syndrome score decreased significantly for both groups over time (p < 0.001), the acid-related dyspepsia (ARD) score decreased significantly in the HST group from 1 week after drug administration (p < 0.05), indicating an improvement in the condition earlier than in the double-dose PPI group. Moreover, in examinations concerning BMI and age, the HST group had a significantly higher improvement degree of ARD score in patients with BMI < 22 (p < 0.05) and aged < 65 years (p < 0.05) than the double-dose PPI group.


HST may be beneficial for patients with PPI-refractory GERD, particularly in non-obese and non-elderly patients with dyspepsia symptoms.


GERD NERD Hangeshashinto Proton pump inhibitor 



Kazuhide Higuchi and Toshihisa Takeuchi contributed to the concept and design of the study. We are grateful to the GERD-4 Study Group (Tetsuo Arakawa, Kazuma Fujimoto, Motoyasu Kusano, Kazunari Tominaga) for providing a useful reference for the design of this study. All authors approved the final version of the manuscript. We thank Nouvelle Place Inc. Tokyo, Japan, for their great support on data management and statistical analysis. We would like to thank Editage ( for English language editing. We thank Chinatsu Saito, Yoshinori Ozaki of Tsumura Co., Ltd. Tokyo, Japan, who received information on hangeshashinto for research planning. This research was funded by Tsumura Co., Ltd. Tokyo, Japan.

Compliance with ethical standards

Conflict of interest

Kazuhide Higuchi has received honoraria from Tsumura Co,. Ltd.

Supplementary material

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Supplementary material 1 (DOCX 23 kb)
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Supplementary material 3 (DOCX 21 kb)
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Supplementary material 4 (DOCX 17 kb)


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Copyright information

© Japanese Society of Gastroenterology 2019

Authors and Affiliations

  • Toshihisa Takeuchi
    • 1
    Email author
  • Hitoshi Hongo
    • 2
  • Tsuguhiro Kimura
    • 2
  • Yuichi Kojima
    • 1
  • Satoshi Harada
    • 3
  • Kazuhiro Ota
    • 3
  • Nozomi Takeuchi
    • 4
  • Takao Noguchi
    • 5
  • Takuya Inoue
    • 6
  • Mitsuyuki Murano
    • 7
  • Kazuhide Higuchi
    • 3
  1. 1.Osaka Medical College Hospital Endoscopy CenterTakatsukiJapan
  2. 2.Fujita Gastroenterology HospitalOsakaJapan
  3. 3.Department of Internal Medicine IIOsaka Medical College HospitalOsakaJapan
  4. 4.Settsu ClinicOsakaJapan
  5. 5.Noguchi ClinicOsakaJapan
  6. 6.Inoue Gastroenterology ClinicOsakaJapan
  7. 7.Murano ClinicOsakaJapan

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