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Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus
  1. Kwong Ming Fock1,
  2. Nicholas Talley2,
  3. Khean Lee Goh3,
  4. Kentaro Sugano4,
  5. Peter Katelaris5,
  6. Gerald Holtmann6,
  7. John E Pandolfino7,
  8. Prateek Sharma8,
  9. Tiing Leong Ang1,
  10. Michio Hongo9,
  11. Justin Wu10,
  12. Minhu Chen11,
  13. Myung-Gyu Choi12,
  14. Ngai Moh Law1,
  15. Bor-Shyang Sheu13,
  16. Jun Zhang14,
  17. Khek Yu Ho15,
  18. Jose Sollano16,
  19. Abdul Aziz Rani17,
  20. Chomsri Kositchaiwat18,
  21. Shobna Bhatia19
  1. 1Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore
  2. 2Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia
  3. 3Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  4. 4Department of Medicine, Jichi Medical University, Tochigi, Japan
  5. 5Gastroenterology Department, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia
  6. 6Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia
  7. 7Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
  8. 8University of Kansas and VA Medical Center, Kansas City, Kansas, USA
  9. 9Department of Comprehensive Medicine, Tohoku University, Sendai, Japan
  10. 10Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China
  11. 11Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
  12. 12Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
  13. 13Department of Internal Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan
  14. 14The Second Affiliated Hospital, Xian Jiaotong University, Xian, China
  15. 15Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore
  16. 16Department of Medicine, University of Sano Tomas, Manila, Philippines
  17. 17Faculty of Medicine, University of Indonesia, Jakarta, Indonesia
  18. 18Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
  19. 19Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India
  1. Correspondence to Professor Kwong Ming Fock, Department of Gastroenterology and Hepatology, Changi General Hospital, 2 Simei Street 3, Singapore 529889, Singapore; Kwong_ming_fock{at}cgh.com.sg

Abstract

Objective 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.

Methods 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.

Results 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.

Conclusions These guidelines standardise the management of patients with refractory gastro-oesophageal reflux disease and Barrett's oesophagus in the Asia-Pacific region.

  • GASTROESOPHAGEAL REFLUX DISEASE
  • BARRETT'S OESOPHAGUS

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