2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease
정혜경, 태정현, 송경호, 강승주, 박종규, 공은정, 신정은, 임현철, 이상길, 정다현, 최윤진, 서승인, 김준성, 이정민, 김범진, 강선형, 박찬혁, 최석채, 권중구, 박경식, 박무인, 이태희, 김승영, 조영신, 이한홍, 정기욱, 김도훈, 문희석, Miwa Hirota, Chen Chien-Lin, Gonlachanvit Sutep, Ghoshal Uday C., Wu Justin C. Y., Siah Kewin T. H., Hou Xiaohua, Oshima Tadayuki, 최미영, 이광재,
소속 상세정보
정혜경 ( Jung Hye-Kyung )
Ewha Womans University College of Medicine Department of Internal Medicine
태정현 ( Tae Chung-Hyun )
Ewha Womans University College of Medicine Department of Internal Medicine
송경호 ( Song Kyung-Ho )
CHA University School of Medicine CHA Ilsan Medical Center Department of Internal Medicine
강승주 ( Kang Seung-Joo )
Seoul National University Hospital Gangnam Center Department of Internal Medicine
박종규 ( Park Jong-Kyu )
University of Ulsan College of Medicine Gangneung Asan Hospital Department of Internal Medicine
공은정 ( Gong Eun-Jeong )
University of Ulsan College of Medicine Gangneung Asan Hospital Department of Internal Medicine
신정은 ( Shin Jeong-Eun )
Dankook University College of Medicine Department of Internal Medicine
임현철 ( Lim Hyun-Chul )
Yonsei University College of Medicine Yongin Severance Hospital Department of Internal Medicine
이상길 ( Lee Sang-Kil )
Yonsei University College of Medicine Severance Hospital Department of Internal Medicine
정다현 ( Jung Da-Hyun )
Yonsei University College of Medicine Severance Hospital Department of Internal Medicine
최윤진 ( Choi Yoon-Jin )
Yonsei University College of Medicine Severance Hospital Department of Internal Medicine
서승인 ( Seo Seung-In )
Hallym University College of Medicine Kangdong Sacred Heart Hospital Department of Internal Medicine
김준성 ( Kim Joon-Sung )
Catholic University College of Medicine Incheon St. Mary’s Hospital Department of Internal Medicine
이정민 ( Lee Jung-Min )
CHA University CHA Gangnam Medical Center Digestive Disease Center
김범진 ( Kim Beom-Jin )
Chung-Ang University College of Medicine Department of Internal Medicine
강선형 ( Kang Sun-Hyung )
Chungnam National University School of Medicine Chungnam National University Hospital Department of Gastroenterology
박찬혁 ( Park Chan-Hyuk )
Hanyang University College of Medicine Hanyang University Guri Hospital Department of Internal Medicine
최석채 ( Choi Suck-Chei )
Wonkwang University School of Medicine Department of Internal Medicine
권중구 ( Kwon Joong-Goo )
Daegu Catholic University School of Medicine Department of Internal Medicine
박경식 ( Park Kyung-Sik )
Keimyung University School of Medicine Department of Internal Medicine
박무인 ( Park Moo-In )
Kosin University College of Medicine Department of Internal Medicine
이태희 ( Lee Tae-Hee )
Soonchunhyang University Seoul Hospital Department of Internal Medicine
김승영 ( Kim Seung-Young )
Korea University College of Medicine Department of Internal Medicine
조영신 ( Cho Young-Sin )
Soonchunhyang University Cheonan Hospital Department of Internal Medicine
이한홍 ( Lee Han-Hong )
Catholic University College of Medicine Seoul St. Mary’s Hospital Department of Surgery
정기욱 ( Jung Kee-Wook )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
김도훈 ( Kim Do-Hoon )
University of Ulsan College of Medicine Asan Medical Center Department of Gastroenterology
문희석 ( Moon Hee-Seok )
Chungnam National University School of Medicine Department of Internal Medicine
( Miwa Hirota )
Hyogo College of Medicine Department of Internal Medicine
( Chen Chien-Lin )
Tzu Chi University College of Medicine Department of Public Health
( Gonlachanvit Sutep )
Chulalongkorn University Faculty of Medicine Department of Medicine
( Ghoshal Uday C. )
Sanjay Gandhi Postgraduate Institute of Medical Sciences Department of Gastroenterology
( Wu Justin C. Y. )
Chinese University of Hong Kong Faculty of Medicine Department of Medicine and Therapeutics
( Siah Kewin T. H. )
National University of Singapore Yong Loo Lin School of Medicine Department of Medicine
( Hou Xiaohua )
Huazhong University of Science and Technology Tongji Medical College Union Hospital Division of Gastroenterology
( Oshima Tadayuki )
Hyogo College of Medicine Department of Internal Medicine
최미영 ( Choi Mi-Young )
National Evidence-Based Healthcare Collaborating Agency Division of Healthcare Technology Assessment Research
이광재 ( Lee Kwang-Jae )
Ajou University School of Medicine Department of Gastroenterology
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.
키워드
Diagnosis; Gastroesophageal reflux disease; Guideline; Meta-analysis; Treatment
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