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Title: Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: An update focusing on refractory reflux disease and Barrett's oesophagus
Authors: Kwong Ming Fock
Nicholas Talley
Khean Lee Goh
Kentaro Sugano
Peter Katelaris
Gerald Holtmann
John E. Pandolfino
Prateek Sharma
Tiing Leong Ang
Michio Hongo
Justin Wu
Minhu Chen
Myung Gyu Choi
Ngai Moh Law
Bor Shyang Sheu
Jun Zhang
Khek Yu Ho
Jose Sollano
Abdul Aziz Rani
Chomsri Kositchaiwat
Shobna Bhatia
Changi General Hospital
University of Newcastle, Australia
University of Malaya
Jichi Medical University
The University of Sydney
University of Queensland
Northwestern University Feinberg School of Medicine
University of Kansas
Tohoku University
Chinese University of Hong Kong
Sun Yat-Sen University
The Catholic University of Korea
National Cheng Kung University Hospital
Xi'an Jiaotong University
National University Hospital, Singapore
University of Sano Tomas
Universitas Indonesia
Mahidol University
King Edward Memorial Hospital India
Keywords: Medicine
Issue Date: 1-Sep-2016
Citation: Gut. Vol.65, No.9 (2016), 1402-1415
Abstract: © 2016 Published by the BMJ Publishing Group Limited. 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.
ISSN: 14683288
Appears in Collections:Scopus 2016-2017

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