Diagnosis and treatment of gastroesophageal reflux disease: 22 consensus recommendations for Asian population consensus guidelines

Introduction Gastroesophageal reflux disease (GERD) is a disease in which stomach contents reflux to or outside of the esophagus, causing uncomfortable symptoms or complications
.

GERD is heterogeneous in clinical manifestations, test results, and response to treatment
.

The 2020 Seoul GERD Clinical Practice Guidelines Consensus focuses on the diagnosis and treatment of GERD in Asian populations, and it puts forward 22 statement recommendations
.

2020 Seoul Consensus: Definition and Epidemiology of Diagnosis and Treatment of GERD 1.
GERD is a disease in which stomach contents flow back into the esophagus or oral cavity, causing uncomfortable symptoms or complications
.

[Level of Evidence: Not Applicable (NA); Strength of Recommendation: NA] 2.
Non-erosive reflux disease (NERD) is a subcategory of GERD, which is characterized by the absence of esophageal mucosal damage confirmed by endoscopy, 24 Hourly dynamic pH impedance monitoring observed abnormally increased gastroesophageal reflux symptoms
.

(Level of Evidence: NA; Strength of Recommendation: NA) 3.
Reflux hypersensitivity is defined as the presence of retrosternal symptoms, including heartburn or chest pain caused by physiological reflux in the absence of an abnormal increase in gastroesophageal reflux
.

(Level of Evidence: NA; Strength of Recommendation: NA) 4.
Functional heartburn is defined as burning-like post-sternal discomfort or pain in the absence of GERD, and acid suppression treatment is ineffective
.

(Level of Evidence: NA; Strength of Recommendation: NA) 5.
Refractory GERD is defined as no improvement in symptoms after administration of standard doses of acid inhibitors for ≥8 weeks
.

(Level of Evidence: NA; Strength of Recommendation: NA) 6.
GERD can cause various extra-esophageal symptoms, such as cough, asthma, hoarseness, or non-cardiac chest pain (NCCP)
.

Extra-esophageal GERD symptoms may or may not be accompanied by typical GERD symptoms
.

(Level of Evidence: NA; Strength of Recommendation: NA) 7.
The prevalence of GERD in Asian countries is increasing
.

(Level of Evidence: Moderate; Strength of Recommendation: NA) Diagnosis of GERD 8.
A symptom-based diagnostic questionnaire is helpful for accurate diagnosis of GERD
.

(Level of Evidence: Low; Strength of Recommendation: Weak) 9.
For patients with typical GERD symptoms, a 2-week standard-dose proton pump inhibitor (PPI) test should be recommended as a sensitive and practical test for the diagnosis of GERD
.

(Level of Evidence: Moderate; Strength of Recommendation: Strong) 10.
Endoscopy with or without biopsy can be recommended for the diagnosis of GERD and exclude other organic diseases
.

(Level of evidence: very low; strength of recommendation: strong) 11.
Endoscopic monitoring is recommended for patients with long-segment Barrett's esophagus
.

(Level of evidence: very low; strength of recommendation: strong) 12.
24-hour dynamic pH impedance monitoring is suitable for patients with GERD who have failed PPI therapy
.

This test is also recommended before anti-reflux surgery
.

(Level of evidence: very low; strength of recommendation: strong) 13.
In Asian adults, esophageal acid total exposure time ≥ 4% was judged to be an abnormal result
.

(Level of Evidence: Moderate; Strength of Recommendation: Weak) 14.
Esophageal manometry can be used to assess peristaltic function and rule out other movement disorders
.

Therefore, patients with GERD should undergo esophageal manometry before anti-reflux surgery
.

(Level of Evidence: Low; Strength of Recommendation: Strong) 15.
New impedance parameters (including baseline impedance and peristaltic waves induced by swallowing after reflux) are promising for the diagnosis of GERD and improve the diagnostic rate of GERD
.

(Level of Evidence: Low; Strength of Recommendation: Weak) Treatment of GERD 16.
It is recommended that overweight patients or patients diagnosed with obesity improve the symptoms of GERD through weight loss
.

(Level of Evidence: Moderate; Strength of Recommendation: Strong) 17.
It is recommended to give a standard dose of PPI (once a day for 4-8 weeks) as the initial treatment for GERD
.

(Level of Evidence: High; Strength of Recommendation: Strong) 18.
For GERD patients whose standard-dose PPI treatment is not effective, double-dose PPI therapy may be effective
.

(Level of Evidence: Moderate; Strength of Recommendation: Weak) 19.
For the long-term management of patients with NERD or mild erosive reflux disease, the efficacy of on-demand PPI therapy is equivalent to that of continuous daily PPI therapy
.

(Level of Evidence: Moderate; Strength of Recommendation: Weak) 20.
For patients with typical GERD symptoms, PPI is recommended for the treatment of NCCP
.

(Level of Evidence: Moderate; Strength of Recommendation: Strong) 21.
For the initial treatment of GERD patients, potassium-competitive acid blockers (P-CAB) are as effective as PPI
.

(Level of Evidence: Moderate; Strength of Recommendation: Strong) 22.
Anti-reflux surgery can be recommended as an alternative to PPI maintenance therapy to improve the symptoms and quality of life of GERD patients
.

(Level of Evidence: Moderate; Strength of Recommendation: Weak) Reference: Korean Society of Neurogastroenterology and Motility.
2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease[J].
J Neurogastroenterol Motil.
2021 Oct 30;27(4): 453-481.
doi: 10.
5056/jnm21077.