Fock Kwong Ming, Talley Nicholas J, Fass Ronnie, Goh Khean Lee, Katelaris Peter, Hunt Richard, Hongo Michio, Ang Tiing Leong, Holtmann Gerald, Nandurkar Sanjay, Lin San Ren, Wong Benjamin C Y, Chan Francis K L, Rani Abdul Aziz, Bak Young-Tae, Sollano Jose, Ho Khek Yu, Manatsathit Sathoporn
Division of Gastroenterology, Department of Medicine, Changi General Hospital, Singapore.
J Gastroenterol Hepatol. 2008 Jan;23(1):8-22. doi: 10.1111/j.1440-1746.2007.05249.x.
Since the publication of the Asia-Pacific GERD consensus in 2004, more data concerning the epidemiology and management of gastroesophageal reflux disease (GERD) have emerged. An evidence based review and update was needed.
A multidisciplinary group developed consensus statements using the Delphi approach. Relevant data were presented, and the quality of evidence, strength of recommendation, and level of consensus were graded.
GERD is increasing in frequency in Asia. Risk factors include older age, male sex, race, family history, higher socioeconomic status, increased body mass index, and smoking. Symptomatic response to a proton pump inhibitor (PPI) test is diagnostic in patients with typical symptoms if alarm symptoms are absent. A negative pH study off therapy excludes GERD if a PPI test fails. The role for narrow band imaging, capsule endoscopy, and wireless pH monitoring has not yet been undefined. Diagnostic strategies in Asia must consider coexistent gastric cancer and peptic ulcer. Weight loss and elevation of head of bed improve reflux symptoms. PPIs are the most effective medical treatment. On-demand therapy is appropriate for nonerosive reflux disease (NERD) patients. Patients with chronic cough, laryngitis, and typical GERD symptoms should be offered twice daily PPI therapy after excluding non-GERD etiologies. Fundoplication could be offered to GERD patients when an experienced surgeon is available. Endoscopic treatment of GERD should not be offered outside clinical trials.
Further studies are needed to clarify the role of newer diagnostic modalities and endoscopic therapy. Diagnostic strategies for GERD in Asia must consider coexistent gastric cancer and peptic ulcer. PPIs remain the cornerstone of therapy.
自2004年亚太地区胃食管反流病（GERD）共识发表以来，出现了更多关于GERD流行病学和管理的资料。因此需要进行基于证据的综述和更新。
一个多学科小组采用德尔菲法制定了共识声明。展示了相关数据，并对证据质量、推荐强度和共识水平进行了分级。
GERD在亚洲的发病率正在上升。危险因素包括年龄较大、男性、种族、家族史、较高的社会经济地位、体重指数增加和吸烟。如果没有报警症状，质子泵抑制剂（PPI）试验的症状反应对有典型症状的患者具有诊断意义。如果PPI试验失败，治疗停药后的pH监测阴性可排除GERD。窄带成像、胶囊内镜和无线pH监测的作用尚未明确。亚洲的诊断策略必须考虑并存的胃癌和消化性溃疡。减轻体重和抬高床头可改善反流症状。PPI是最有效的药物治疗。按需治疗适用于非糜烂性反流病（NERD）患者。在排除非GERD病因后，对于慢性咳嗽、喉炎和有典型GERD症状的患者，应给予每日两次的PPI治疗。当有经验丰富的外科医生时，可对GERD患者进行胃底折叠术。GERD的内镜治疗不应在临床试验之外进行。
需要进一步研究以阐明新型诊断方法和内镜治疗的作用。亚洲GERD的诊断策略必须考虑并存的胃癌和消化性溃疡。PPI仍然是治疗的基石。
