Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus.
Since the publication of the Asia-Pacific consensus on gastro-oesophageal reflux disease in 2008, there has been further scientific advancement in this field. This updated consensus focuses on proton pump inhibitor-refractory reflux disease and Barrett's oesophagus.



A steering committee identified three areas to address: (1) burden of disease and diagnosis of reflux disease; (2) proton pump inhibitor-refractory reflux disease; (3) Barrett's oesophagus. Three working groups formulated draft statements with supporting evidence. Discussions were done via email before a final face-to-face discussion. We used a Delphi consensus process, with a 70% agreement threshold, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to categorise the quality of evidence and strength of recommendations.



A total of 32 statements were proposed and 31 were accepted by consensus. A rise in the prevalence rates of gastro-oesophageal reflux disease in Asia was noted, with the majority being non-erosive reflux disease. Overweight and obesity contributed to the rise. Proton pump inhibitor-refractory reflux disease was recognised to be common. A distinction was made between refractory symptoms and refractory reflux disease, with clarification of the roles of endoscopy and functional testing summarised in two algorithms. The definition of Barrett's oesophagus was revised such that a minimum length of 1 cm was required and the presence of intestinal metaplasia no longer necessary. We recommended the use of standardised endoscopic reporting and advocated endoscopic therapy for confirmed dysplasia and early cancer.



These guidelines standardise the management of patients with refractory gastro-oesophageal reflux disease and Barrett's oesophagus in the Asia-Pacific region.
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore.
Kwong Ming
KM
Fock
Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
Nicholas
N
Talley
Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
Khean Lee
KL
Goh
Department of Medicine, Jichi Medical University, Tochigi, Japan.
Kentaro
K
Sugano
Gastroenterology Department, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
Peter
P
Katelaris
Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia.
Gerald
G
Holtmann
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
John E
JE
Pandolfino
University of Kansas and VA Medical Center, Kansas City, Kansas, USA.
Prateek
P
Sharma
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore.
Tiing Leong
TL
Ang
Department of Comprehensive Medicine, Tohoku University, Sendai, Japan.
Michio
M
Hongo
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China.
Justin
J
Wu
Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Minhu
M
Chen
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Myung-Gyu
MG
Choi
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore.
Ngai Moh
NM
Law
Department of Internal Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.
Bor-Shyang
BS
Sheu
The Second Affiliated Hospital, Xian Jiaotong University, Xian, China.
Jun
J
Zhang
Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
Khek Yu
KY
Ho
Department of Medicine, University of Sano Tomas, Manila, Philippines.
Jose
J
Sollano
Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
Abdul Aziz
AA
Rani
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
Chomsri
C
Kositchaiwat
Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India.
Shobna
S
Bhatia
D001208:Asia / Q000453:epidemiology; D001471:Barrett Esophagus / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003697:Delphi Technique; D019468:Disease Management; D004351:Drug Resistance; D016145:Endoscopy, Digestive System / Q000379:methods*; D005764:Gastroesophageal Reflux / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D010139:Pacific Islands / Q000453:epidemiology; D015995:Prevalence; D054328:Proton Pump Inhibitors / Q000494:pharmacology / Q000627:therapeutic use
D054328:Proton Pump Inhibitors
BARRETT'S OESOPHAGUS; GASTROESOPHAGEAL REFLUX DISEASE