232 T. Takashima et al. result, the characteristics of the esophagitis patients without any symptoms questioned by nursing staffs were estimated in this study. Endoscopic examination and clinical symptoms are most reliable for diagnosis of reflux esophagitis in normal clinical situations [1, 4, 5, 8, 27–29]. This study indicated that detection of clinical symptoms of reflux esophagitis was not easy using a short questionnaire administered by nursing staffs. This suggests that precise interview for clinical symptoms and/or a questionnaire for reflux esophagitis might be required for nursing staffs and health practitioners to carry out precise diagnosis of reflux esophagitis. References [1] DeVault, K.R. and Castell, D.O.: Updated guidelines for the diagnosis and treatment of gastroesophageal reflux disease. Am. J. Gastroenterol., 94, 1434–1442, 1999. [2] Armstrong, D., Bennett, J.R., Blum, A.L., Dent, J., De Dombal, F.T., Galmiche, J.P., Lundell, L., Margulies, M., Richter, J.E., Spechler, S.J., Tytgat, G.N., and Wallin, L.: The endoscopic assessment of esophagitis: a progress report on observer agreement. Gastroenterology, 111, 85–92, 1996. [3] Lundell, L.R., Dent, J., Bennett, J.R., Blum, A.L., Armstrong, D., Galmiche, J.P., Johnson, F., Hongo, M., Richter, J.E., Spechler, S.J., Tytgat, G.N.J., and Wallin, L.: Endoscopic assessment of oesophagitis: clinical and functional correlates and further validation of the Los Angeles classification. Gut, 45, 172–180, 1999. [4] Vakil, N., van Zanten, S.V., Kahrilas, P., Dent, J., Jones, R., and the Global Consensus Group: The Montreal definition and classification of gastroesophageal reflux disease: a global evidence-based consensus. Am. J. Gastroenterol., 101, 1900– 1920, 2006. [5] Fock, K.M., Talley, N.J., Fass, R., Goh, K.L., Katelaris, P., Hunt, R., Hongo, M., Ang, T.L., Holtmann, G., Nandurkar, S., Lin, S.R., Wong, B.C., Chan, F.K., Rani, A.A., Bak, Y.T., Sollano, J., Ho, K.Y., and Manatsathit, S.: Asia-Pacific consensus on the management of gastroesophageal reflux disease: update. J. Gastroenterol. Hepatol., 23, 8–22, 2008. [6] Furukawa, N., Iwakiri, R., Koyama, T., Okamoto, K., Yoshida, T., Kashiwagi, Y., Ohyama, T., Noda, T., Sakata, H., and Fujimoto, K.: Proportion of reflux esophagitis in 6010 Japanese adults: prospective evaluation by endoscopy. J. Gastroenterol., 34, 441–444, 1999. [7] Amano, K., Adachi, K., Katsube, T., Watanabe, M., and Kinoshita, Y.: Role of hiatus hernia and gastric mucosal atrophy in the development of reflux esophagitis in the elderly. J. Gastroenterol. Hepatol., 16, 132–136, 2001. [8] Okamoto, K., Iwakiri, R., Mori, M., Hara, M., Oda, K., Danjo, A., Ootani, A., Sakata, H., and Fujimoto, K.: Clinical symptoms in endoscopic reflux esophagitis: evaluation in 8031 adult subjects. Dig. Dis. Sci., 48, 2237–2241, 2003. [9] Fujimoto, K.: Review article: Prevalence and epidemiology of gastro-oesophageal reflux disease in Japan. Aliment. Pharmacol. Ther., 20, 5–8, 2004. [10] Kusano, M., Shimoyama, Y., Sugimoto, S., Kawamura, O., Maeda, M., Minashi, K., Kuribayashi, S., Higuchi, T., Zai, H., Ino, K., Horikoshi, T., Sugiyama, T., Toki, M., Ohwada, T., and Mori, M.: Development and evaluation of FSSG: frequency scale for the symptoms of GERD. J. Gastro- enterol., 39, 888–891, 2004. [11] Shimazu, T., Matsui, T., Furukawa, K., Oshige, K., Mitsuyasu, T., Kiyomizu, A., Ueki, T., and Yao, T.: A prospective study of the prevalence of gastroesophageal reflux disease and confounding factors. J. Gastroenterol., 40, 866–872, 2005. [12] Mishima, I., Adachi, K., Arima, N., Amano, K., Takashima, T., Moritani, M., Furuta, K., and Kinoshita, Y.: Prevalence of endoscopically negative and positive gastroesophageal reflux disease in the Japanese. Scand. J. Gastroenterol., 40, 1005– 1009, 2005. [13] Fujiwara, Y., Higuchi, K., Watanabe, Y., Shiba, M., Watanabe, T., Tominaga, K., Oshitani, N., Matsumoto, T., Nishikawa, H., and Arakawa, T.: Prevalence of gastro- esophageal reflux disease and gastroesophageal reflux disease symptoms in Japan. J. Gastroenterol. Hepatol., 20, 26–29, 2005. [14] Hongo, M., Kinoshita, Y., Shimozuma, K., Kumagai, Y., Sawada, M., and Nii, M.: Psychcometirc validation of the Japanese translation of the quality of life in reflux and dyspepsia questionnaire in patients with heartburn. J. Gastro- enterol., 42, 807–815, 2007. [15] Miyamoto, M., Haruma, K., Kuwabara, M., Nagano, M., Okamoto, T., and Tanaka, M.: Long-term gastroesophageal reflux disease therapy improves reflux symptoms in elderly patients: five-year prospective study in community medicine. J. Gastroenterol. Hepatol., 22, 639–644, 2007. [16] Joh, T., Miwa, H., Higuchi, K., Shimatani, T., Manabe, N., Adachi, K., Wada, T., Sasaki, M., Fujiwara, Y., Hongo, M., Chiba, T., Kinoshita, Y., and the Acid-Related Symptom (ARS) Research Group: Validity of endoscopic classification of nonerosive reflux disease. J. Gastroenterol., 42, 444–449, 2007. [17] Miwa, H., Sasaki, M., Furuta, T., Koike, T., Habu, Y., Ito, M., Fujiwara, Y., Wada, T., Nagahara, A., Hongo, M., Chiba, T., and Kinoshita, Y.: Efficacy of rabeprazole on heartburn symptom resolution in patients with non-erosive and erosive gastro-oesophageal reflux disease: a multicenter study from Japan. Aliment. Pharmacol. Ther., 26, 69–77, 2007. [18] Yoshihara, K., Yamaguichi, K., Kuroki, T., Takashima, T., Inoue, N., Sakata, H., Tsunada, S., Shiraishi, R., Mannen, K., Fujise, T., Nakayama, M., Shimoda, R., Iwakiri, R., and Fujimoto, K.: Dysphagia in adult Japanese is not equivalent to the grade of endoscopic reflux esophagitis. Intern. Med., 46, 1951–1955, 2007. [19] Carlsson, R., Dent, J., Bolling-Sternevald, E., Johnsson, F., Junghard, O., Lauritsen, K., Riley, S., and Lundell, L.: The usefulness of a structured questionnaire in the assessment of symptomatic gastroesophageal reflux disease. Scand. J. Gastroenterol., 33, 1023–1029, 1998. [20] Talley, N.J., Boyce, P., and Jones, M.: Identification of distinct upper and lower gastrointestinal symptom groupings in an urban population. Gut, 42, 690–695, 1998. J. Clin. Biochem. Nutr.