Consensus of gastroesophageal reflux disease in Taiwan with endoscopy‐based approach covered by National Health Insurance

Abstract

Background and aims: Gastroesophageal reflux disease (GERD) is emerging as a clinical complication in the Orient. The consensus comprises recommendations to GERD control under the advantage of endoscopy-based approach covered by the Taiwan National Health Insurance. Methods: The steering committee defined the consensus scope to cover diagnostic, therapeutic, unresolved, controversial, or long-term proton pump inhibitor-related issues to GERD. The literature review emphasized domestic data, after which the draft statements and statement evidence levels were defined. Thirty-five experts of GERD in Taiwan formed the expert group to conduct the consensus conference by a modified Delphi process to vote anonymously to reach a consensus, defined by an agreement of 80% for each statement, and to set the recommendation grade. Advances in Digestive Medicine (2015) xx, 1e10Results: The consensus included 22 statements, including seven on diagnostic approach, seven on therapeutic suggestion, and eight on unresolved, controversial, or long-term proton pump inhibitor-related issues to GERD. The consensus highlighted that the endoscopy approach to GERD can define the disease spectrum and exclude malignant potential. The questionnaire survey can not only define GERD, but also monitor treatment response and quality of life. The consensus addressed suggestions for the unresolved issues related to extraesophageal presentation and adverse concerns of GERD after long-term use of proton pump inhibitors. In the endemic area of upper gastrointestinal cancers, Helicobacter pylori eradication is suggested to reduce progression of gastric precancerous lesions, and endoscopic surveillance of Barrett's esophagus with dysplasia deserves prospective research. Conclusion: The consensus comprises recommendations for the management of GERD in a high upper gastrointestinal cancer area with a national coverage of endoscopic approach.

The benefits and risks of proton pump inhibitor therapy

“…14,15 In brief, there is no persuasive evidence that the association is causal, although this can never be excluded as a possibility. 16 In conclusion, although the possibility of adverse events attributable to PPI therapy cannot be excluded, including pneumonia, enteric infections, CDAD, SBP, and bone fracture, it is important that PPIs are only prescribed to patients who may benefit from them such as patients with reflux esophagitis, PUD, PUB post endoscopic therapy, and patients with a high risk of PUB when taking antiplatelets or NSAIDs. …”