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|Title:||Asia-Pacific consensus on the management of gastroesophageal reflux disease: Update|
|Citation:||Journal of Gastroenterology and Hepatology, 2008; 23(1):8-22|
|Publisher:||Blackwell Publishing Asia|
|Kwong Ming Fock, Nicholas J Talley, Ronnie Fass, Khean Lee Goh, Peter Katelaris, Richard Hunt, Michio Hongo, Tiing Leong Ang, Gerald Holtmann, Sanjay Nandurkar, San Ren Lin, Benjamin CY Wong, Francis KL Chan, Abdul Aziz Rani, Young-Tae Bak, Jose Sollano, Lawrence KY Ho and Sathoporn Manatsathit|
|Abstract:||Background and Aims: Since the publication of the Asia-Pacific GERD consensus in 2004, more data concerning the epidemiology and management of gastroesophageal reflux disease (GERD) have emerged. An evidence based review and update was needed. Methods: A multidisciplinary group developed consensus statements using the Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded. Results: GERD is increasing in frequency in Asia. Risk factors include older age, male sex, race, family history, higher socioeconomic status, increased body mass index, and smoking. Symptomatic response to a proton pump inhibitor (PPI) test is diagnostic in patients with typical symptoms if alarm symptoms are absent. A negative pH study off therapy excludes GERD if a PPI test fails. The role for narrow band imaging, capsule endoscopy, and wireless pH monitoring has not yet been undefined. Diagnostic strategies in Asia must consider coexistent gastric cancer and peptic ulcer. Weight loss and elevation of head of bed improve reflux symptoms. PPIs are the most effective medical treatment. On-demand therapy is appropriate for nonerosive reflux disease (NERD) patients. Patients with chronic cough, laryngitis, and typical GERD symptoms should be offered twice daily PPI therapy after excluding non-GERD etiologies. Fundoplication could be offered to GERD patients when an experienced surgeon is available. Endoscopic treatment of GERD should not be offered outside clinical trials. Conclusions: Further studies are needed to clarify the role of newer diagnostic modalities and endoscopic therapy. Diagnostic strategies for GERD in Asia must consider coexistent gastric cancer and peptic ulcer. PPIs remain the cornerstone of therapy.|
|Keywords:||consensus; erosive esophagitis; non-erosive reflux disease|
|Description:||The definitive version may be found at www.wiley.com Article first published online: 13 DEC 2007|
|Rights:||© 2008 The Authors Journal compilation © 2008 Journal of Gastroenterology and Hepatology Foundation and Blackwell Publishing Asia Pty Ltd|
|Appears in Collections:||Medicine publications|
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