Fock KM et al. (2008) Asia-Pacific consensus on the management of gastroesophageal reflux disease: update. J Gastroenterol Hepatol 23: 8–22

Since the Asia-Pacific consensus report on managing GERD was published in 2004, global definitions of GERD and Barrett's esophagus have been reviewed and new imaging techniques have become available. An updated consensus was, therefore, considered timely, and a multidisciplinary group present the new set of statements that have now been developed.

Data relevant to each statement, the quality of supporting evidence and the level of consensus are all included. From the evidence considered, Fock et al. concluded that the prevalence of GERD in Asia is increasing. Older Asian men with a family history of GERD and high socioeconomic status, who also are more likely to be obese and smoke, are at particularly high risk.

Diagnosis of GERD can still be problematic. An improvement in response to PPI therapy should be considered diagnostic in patients who have only typical symptoms, and in those who additionally present with chronic cough and laryngitis but no alarm symptoms. In Asia, diagnostic algorithms must consider potentially coexistent gastric cancer and peptic ulcer. GERD can be excluded by a negative pH study following failure of a PPI trial. Although new imaging technologies hold much promise, their role in GERD diagnosis in Asia still remains to be defined.

With respect to treatment, the report recommends PPIs as the most effective medical treatment but suggests that weight loss and raising the height of the bed head are also useful. Endoscopic treatment of GERD should be limited to clinical trial populations.