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Gut. 2016 Sep;65(9):1402-15. doi: 10.1136/gutjnl-2016-311715. Epub 2016 Jun 3.

Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus.

Author information

1
Department of Gastroenterology and Hepatology, Changi General Hospital, Singapore, Singapore.
2
Faculty of Health and Medicine, University of Newcastle, Callaghan, New South Wales, Australia.
3
Division of Gastroenterology and Hepatology, Department of Medicine, University of Malaya, Kuala Lumpur, Malaysia.
4
Department of Medicine, Jichi Medical University, Tochigi, Japan.
5
Gastroenterology Department, Concord Hospital, University of Sydney, Sydney, New South Wales, Australia.
6
Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, Queensland, Australia.
7
Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
8
University of Kansas and VA Medical Center, Kansas City, Kansas, USA.
9
Department of Comprehensive Medicine, Tohoku University, Sendai, Japan.
10
Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Shatin, China.
11
Division of Gastroenterology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
12
Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea.
13
Department of Internal Medicine, National Cheng Kung University Hospital, Medical College, National Cheng Kung University, Tainan, Taiwan.
14
The Second Affiliated Hospital, Xian Jiaotong University, Xian, China.
15
Division of Gastroenterology and Hepatology, National University Hospital, Singapore, Singapore.
16
Department of Medicine, University of Sano Tomas, Manila, Philippines.
17
Faculty of Medicine, University of Indonesia, Jakarta, Indonesia.
18
Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
19
Department of Gastroenterology, Seth GS Medical College and King Edward Memorial Hospital, Mumbai, India.

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.

KEYWORDS:

BARRETT'S OESOPHAGUS; GASTROESOPHAGEAL REFLUX DISEASE

PMID:
27261337
DOI:
10.1136/gutjnl-2016-311715
[Indexed for MEDLINE]

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