title: Asia-Pacific consensus on the management of gastroesophageal reflux disease: update.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore. kwong_ming_fock@cgh.com.sg
authors.forename: Kwong Ming
authors.initials: KM
authors.lastname: Fock
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Talley
authors.forename: Ronnie
authors.initials: R
authors.lastname: Fass
authors.forename: Khean Lee
authors.initials: KL
authors.lastname: Goh
authors.forename: Peter
authors.initials: P
authors.lastname: Katelaris
authors.forename: Richard
authors.initials: R
authors.lastname: Hunt
authors.forename: Michio
authors.initials: M
authors.lastname: Hongo
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
authors.forename: Gerald
authors.initials: G
authors.lastname: Holtmann
authors.forename: Sanjay
authors.initials: S
authors.lastname: Nandurkar
authors.forename: San Ren
authors.initials: SR
authors.lastname: Lin
authors.forename: Benjamin C Y
authors.initials: BC
authors.lastname: Wong
authors.forename: Francis K L
authors.initials: FK
authors.lastname: Chan
authors.forename: Abdul Aziz
authors.initials: AA
authors.lastname: Rani
authors.forename: Young-Tae
authors.initials: YT
authors.lastname: Bak
authors.forename: Jose
authors.initials: J
authors.lastname: Sollano
authors.forename: Khek Yu
authors.initials: KY
authors.lastname: Ho
authors.forename: Lawrence K Y
authors.initials: LK
authors.lastname: Ho
authors.forename: Sathoporn
authors.initials: S
authors.lastname: Manatsathit
mesh_terms: D001208:Asia; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D010139:Pacific Islands; D054328:Proton Pump Inhibitors / Q000627:therapeutic use
chemical_list: D054328:Proton Pump Inhibitors