Open Access2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease
Author(s) -
Hye-Kyung Jung,
Chung Hyun Tae,
Kyung Ho Song,
Seumg Joo Kang,
Jong Kyu Park,
Eun Jeong Gong,
Jeong Eun Shin,
Hyun Chul Lim,
Sang Kil Lee,
Da Hyun Jung,
Yoon Jin Choi,
Seung In Seo,
Joon Sung Kim,
Jung Min Lee,
Beom Jin Kim,
Sun Hyung Kang,
Chan Hyuk Park,
Suck Chei Choi,
Joong Goo Kwon,
Kyung Sik Park,
Moo In Park,
Tae Hee Lee,
Seung Young Kim,
Yonung Sin Cho,
Han Hong Lee,
Kee Wook Jung,
Do Hoon Kim,
Hee Seok Moon,
Miyoung Choi,
Kwang Jae Lee
Publication year - 2022
Publication title -
the korean journal of medicine
Language(s) - English
Resource type - Journals
eISSN - 2289-0769
pISSN - 1738-9364
DOI - 10.3904/kjm.2022.97.2.70
Subject(s) - gerd , medicine , gastroenterology , nerd , reflux , proton pump inhibitor , esophagus , disease , population , reflux esophagitis , esophagitis , environmental health
Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis. Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.