위식도 역류 질환의 진단과 치료에 관한 서울 진료지침 2020open access2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease
- Other Titles
- 2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease
- Authors
- 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; 최미영; 이광재
- Issue Date
- Apr-2022
- Publisher
- 대한내과학회
- Keywords
- Diagnosis; Gastroesophageal reflux disease; Guideline; Meta-analysis; Treatment
- Citation
- 대한내과학회지, v.97, no.2, pp.70 - 92
- Indexed
- KCI
OTHER
- Journal Title
- 대한내과학회지
- Volume
- 97
- Number
- 2
- Start Page
- 70
- End Page
- 92
- URI
- https://scholarworks.bwise.kr/hanyang/handle/2021.sw.hanyang/138877
- DOI
- 10.3904/kjm.2022.97.2.70
- ISSN
- 1738-9364
- 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.
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