2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease

Hye-Kyung Jung¹, Chung Hyun Tae¹, Kyung Ho Song², Seung Joo Kang³, Jong Kyu Park⁴, Eun Jeong Gong⁴, Jeong Eun Shin⁵, Hyun Chul Lim⁶, Sang Kil Lee⁷, Da Hyun Jung⁷, Yoon Jin Choi⁷, Seung In Seo⁸, Joon Sung Kim⁹, Jung Min Lee¹⁰, Beom Jin Kim¹¹, Sun Hyung Kang¹², Chan Hyuk Park¹³, Suck Chei Choi¹⁴, Joong Goo Kwon¹⁵, Kyung Sik Park¹⁶, Moo In Park¹⁷, Tae Hee Lee¹⁸, Seung Young Kim¹⁹, Young Sin Cho²⁰, Han Hong Lee²¹, Kee Wook Jung²², Do Hoon Kim²², Hee Seok Moon²³, Hirota Miwa²⁴, Chien-Lin Chen²⁵, Sutep Gonlachanvit²⁶, Uday C Ghoshal²⁷, Justin C Y Wu²⁸, Kewin T H Siah^{29

30}, Xiaohua Hou³¹, Tadayuki Oshima³², Mi-Young Choi³³, Kwang Jae Lee³⁴; Korean Society of Neurogastroenterology and Motility

Affiliations

¹ Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
² Division of Gastroenterology, Department of Internal Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Ilsan, Jeollabuk-do, Korea.
³ Department of Internal Medicine, Seoul National University Hospital Gangnam Center, Seoul, Korea.
⁴ Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Korea.
⁵ Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea.
⁶ Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Korea.
⁷ Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
⁸ Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
⁹ Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
¹⁰ Digestive Disease Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
¹¹ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
¹² Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
¹³ Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Korea.
¹⁴ Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Korea.
¹⁵ Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
¹⁶ Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
¹⁷ Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
¹⁸ Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
¹⁹ Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
²⁰ Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan, Hospital, Cheonan, Chungcheongnamdo, Korea.
²¹ Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
²² Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²³ Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
²⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
²⁵ Institute of Medical Sciences, Tzu Chi University, and Department of Public Health, College of Medicine, Tzu Chi University, Hualien City, Taiwan.
²⁶ Center of Excellence on Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
²⁷ Departments of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India.
²⁸ Institute of Digestive Disease, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, China.
²⁹ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³⁰ Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore.
³¹ Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
³² Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
³³ Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
³⁴ Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea.

PMID: 34642267
PMCID: PMC8521465
DOI: 10.5056/jnm21077

Review

2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease

Hye-Kyung Jung et al. J Neurogastroenterol Motil. 2021.

. 2021 Oct 30;27(4):453-481.

doi: 10.5056/jnm21077.

Authors

Affiliations

¹ Department of Internal Medicine, Ewha Womans University College of Medicine, Seoul, Korea.
² Division of Gastroenterology, Department of Internal Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Ilsan, Jeollabuk-do, Korea.
³ Department of Internal Medicine, Seoul National University Hospital Gangnam Center, Seoul, Korea.
⁴ Department of Internal Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Gangwon-do, Korea.
⁵ Department of Internal Medicine, Dankook University College of Medicine, Cheonan, Chungcheongnam-do, Korea.
⁶ Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Gyeonggi-do, Korea.
⁷ Division of Gastroenterology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
⁸ Division of Gastroenterology, Department of Internal Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
⁹ Division of Gastroenterology, Department of Internal Medicine, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea.
¹⁰ Digestive Disease Center, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
¹¹ Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
¹² Department of Gastroenterology, Chungnam National University Hospital, Chungnam National University School of Medicine, Daejeon, Korea.
¹³ Department of Internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Gyeonggi-do, Korea.
¹⁴ Department of Internal Medicine and Digestive Disease Research Institute, Wonkwang University School of Medicine, Iksan, Jeollabuk-do, Korea.
¹⁵ Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea.
¹⁶ Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Korea.
¹⁷ Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea.
¹⁸ Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.
¹⁹ Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
²⁰ Division of Gastroenterology, Department of Internal Medicine, Soonchunhyang University Cheonan, Hospital, Cheonan, Chungcheongnamdo, Korea.
²¹ Department of Surgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
²² Department of Gastroenterology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
²³ Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea.
²⁴ Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan.
²⁵ Institute of Medical Sciences, Tzu Chi University, and Department of Public Health, College of Medicine, Tzu Chi University, Hualien City, Taiwan.
²⁶ Center of Excellence on Neurogastroenterology and Motility, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
²⁷ Departments of Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Science, Lucknow, India.
²⁸ Institute of Digestive Disease, Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, China.
²⁹ Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
³⁰ Division of Gastroenterology and Hepatology, University Medicine Cluster, National University Hospital, Singapore.
³¹ Department of Gastroenterology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei Province, China.
³² Division of Gastroenterology and Hepatology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
³³ Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Korea.
³⁴ Department of Gastroenterology, Ajou University School of Medicine, Suwon, Gyeonggi-do, Korea.

PMID: 34642267
PMCID: PMC8521465
DOI: 10.5056/jnm21077

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.

Keywords: Diagnosis; Gastroesophageal reflux disease; Guideline; Meta-analysis; Treatment.

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Conflict of interest statement

Conflicts of interest: None.

Figures

**Figure 1**
The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) flow diagram of the systematic review process of the efficacy of proton pump inhibitors in patients with non-cardiac chest pain.

**Figure 2**
Algorithm for the diagnosis and treatment of gastroesophageal reflux disease.

See this image and copyright information in PMC

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2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease

Affiliations

2020 Seoul Consensus on the Diagnosis and Management of Gastroesophageal Reflux Disease

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

LinkOut - more resources

Full Text Sources

Medical