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.