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KMID : 0882420220970020070
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Korean Journal of Medicine
2022 Volume.97 No. 2 p.70 ~ p.92
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2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease
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Jung Hye-Kyung
Tae Chung-Hyun
Song Kyung-Ho
Kang Seung-Joo
Park Jong-Kyu
Gong Eun-Jeong
Shin Jeong-Eun
Lim Hyun-Chul
Lee Sang-Kil
Jung Da-Hyun
Choi Yoon-Jin
Seo Seung-In
Kim Joon-Sung
Lee Jung-Min
Kim Beom-Jin
Kang Sun-Hyung
Park Chan-Hyuk
Choi Suck-Chei
Kwon Joong-Goo
Park Kyung-Sik
Park Moo-In
Lee Tae-Hee
Kim Seung-Young
Cho Young-Sin
Lee Han-Hong
Jeong Kee-Wook
Kim Do-Hoon
Moon Hee-Seok
Choi Mi-Young
Lee-Gwang-Jae
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Abstract
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Gastroesophageal reflux disease (GERD) is a condition in which gastric contents regurgitate into the esophagus or beyond, resulting in either troublesome symptoms or complications. GERD is heterogeneous in terms of varied manifestations, test findings, and treatment responsiveness. GERD diagnosis can be established with symptomatology, pathology, or physiology. Recently the Lyon consensus defined the “proven GERD” with concrete evidence for reflux, including advanced grade erosive esophagitis (Los Angeles classification grades C and or D esophagitis), long-segment Barrett’s mucosa or peptic strictures on endoscopy or distal esophageal acid exposure time > 6% on 24-hour ambulatory pH-impedance monitoring. However, some Asian researchers have different opinions on whether the same standards should be applied to the Asian population. The prevalence of GERD is increasing in Asia. The present evidence-based guidelines were developed using a systematic review and meta-analysis approach. In GERD with typical symptoms, a proton pump inhibitor test can be recommended as a sensitive, cost-effective, and practical test for GERD diagnosis. Based on a meta-analysis of 19 estimated acid-exposure time values in Asians, the reference range upper limit for esophageal acid exposure time was 3.2% (95% confidence interval 2.7-3.9%) in the Asian countries. Esophageal manometry and novel impedance measurements, including mucosal impedance and a post-reflux swallow-induced peristaltic wave, are promising in discrimination of GERD among different reflux phenotypes, thus increasing its diagnostic yield. We also propose a long-term strategy of evidence-based GERD treatment with proton pump inhibitors and other drugs.
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KEYWORD
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Diagnosis, Gastroesophageal reflux disease, Guideline, Meta-analysis, Treatment
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