| Symposium 6(JSGE・JGES) |
| Sat. November 23rd 9:00 - 11:30 Room 2: Kobe International Exhibition Hall No.2 Building Hall (South) |
| New Frontiers in GERD Management | |||
| Justin Wu | |||
| The Chinese University of Hong Kong | |||
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| Gastroesophageal reflux disease is on the rise in Asia. Risk factors of GERD are evolving in Asia: Westernized diet, obesity and metabolic syndrome are also contributing factors to the rising prevalence of GERD in Asia. Asian GERD patients share similar pathophysiology with the Western counterparts, with transient lower esophageal sphincter relaxation as the single most important mechanism. Lower prevalence of hiatus hernia and lesser impact of obesity may account for the milder severity of erosive esophagitis and other GERD complications in Asia. GERD is primarily a clinical symptom-based diagnosis and there is a lack of sensitive confirmatory investigation. Despite the low diagnostic yield, upper endoscopy and Helicobacter pylori eradication are recommended in the population with high prevalence of H. pylori by the WGO Guidelines because the symptoms of GERD and H. pylori related diseases may be difficult to distinguish. The current guidelines also recommend extended course of proton pump inhibitor therapy up to 8 weeks to ascertain the symptom-based diagnosis of GERD. Despite the less severe disease profile in terms of complications, Asian GERD patients have lower symptom response rate to proton pump inhibitor. Patients with poor response to PPI may benefit from adjunct alginate-antacid, modified-release PPI or double-dose PPI. An assessment of anatomy, motor function, reflux burden and symptomatic phenotype is essential for proper diagnosis and management. Future GERD management strategies will be personalized based on the mechanism and degree of refluxate exposure, esophageal clearance function, anatomical disruption of gastroesophageal junction and psychometrics defining symptomatic presentations. The latest international consensus suggests ambulatory off-PPI pH monitoring as the primary investigation of choice for PPI non-responders. Combined pH-impedance monitoring is indicated if there is severe esophagitis and high suspicion of persistent acid or non-acid reflux. Laparoscopic fundoplication remains the operative treatment of choice with comparable long-term efficacy with PPI if there is objective evidence of reflux as confirmed by reflux testing. Emerging therapies such as LES augmentation therapy (implanted magnetic device, electrical stimulation and radiofrequency energy) have been marketed but their role in the management algorithm is yet to be determined. |
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Index Term 1: Gastroesophageal reflux disease Index Term 2: Esophagitis |
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