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