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2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease.

ABSTRACT: 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.

SUBMITTER: Jung HK

PROVIDER: S-EPMC8521465 | biostudies-literature | 2021 Oct

REPOSITORIES: biostudies-literature

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2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease.

Jung Hye-Kyung HK Tae Chung Hyun CH Song Kyung Ho KH Kang Seung Joo SJ Park Jong Kyu JK Gong Eun Jeong EJ Shin Jeong Eun JE Lim Hyun Chul HC Lee Sang Kil SK Jung Da Hyun DH Choi Yoon Jin YJ Seo Seung In SI Kim Joon Sung JS Lee Jung Min JM Kim Beom Jin BJ Kang Sun Hyung SH Park Chan Hyuk CH Choi Suck Chei SC Kwon Joong Goo JG Park Kyung Sik KS Park Moo In MI Lee Tae Hee TH Kim Seung Young SY Cho Young Sin YS Lee Han Hong HH Jung Kee Wook KW Kim Do Hoon DH Moon Hee Seok HS Miwa Hirota H Chen Chien-Lin CL Gonlachanvit Sutep S Ghoshal Uday C UC Wu Justin C Y JCY Siah Kewin T H KTH Hou Xiaohua X Oshima Tadayuki T Choi Mi-Young MY Lee Kwang Jae KJ

Journal of neurogastroenterology and motility 20211001 4

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 (L ...[more]

PMID: 34642267

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Project description:Background and objectiveGastroesophageal reflux disease (GERD)-associated cough is defined as a special GERD with a predominant cough symptom and is a common cause of chronic cough. This review summarizes our current understanding on the pathogenesis and management of GERD-associated cough.MethodsMain literatures on the pathogenesis and management of GERD-associated cough were reviewed and our understandings derived from the published studies were showed then.Key content and findingsAlthough esophageal-tracheobronchial reflex mainly underlies the pathogenesis of GERD-associated cough, its counterpart-tracheobronchial-esophageal reflex might exist and initiate the cough due to reflux induced by upper respiratory tract infection through the signaling of transient receptor potential vanilloid 1 linking airway and esophagus. The presence of reflux-associated symptoms such as regurgitation and heartburn along with coughing suggests an association between cough and GERD, which is supported by the objective evidence of abnormal reflux as detected by reflux monitoring. Although there is no general consensus, esophageal reflux monitoring provides the main diagnostic criteria for GERD-associated cough. Despite that acid exposure time and symptom associated probability are useful and mostly employed reflux diagnostic criteria, they are imperfect and far from being the gold standard. Acid suppressive therapy has long been recommended as the first choice for GERD-associated cough. However, the overall benefits of proton pump inhibitors have been controversial and need to be further assessed, especially in patients with cough due to non-acid reflux. Neuromodulators have demonstrated potential therapeutic effects for refractory GERD-associated cough, for which anti-reflux surgery may also be a promising treatment option.ConclusionsTracheobronchial-esophageal reflex might initiate reflux-induced cough provoked by the upper respiratory tract infection. It is necessary to optimize the current standards and to explore new criteria with higher diagnostic potency. Acid suppressive therapy is the first choice for GERD-associated cough, followed by neuromodulators and anti-reflux surgery for refractory GERD-associated cough.

Dataset Information

2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease.

Publications

2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease.

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