Journal of Neurogastroenterology and Motility : eISSN 2093-0887 / pISSN 2093-0879

Table. 2.

Summary of the Seoul Consensus on Gastroesophageal Reflux Disease

Level of evidence Strength of recommendation
Definition and epidemiology
1 GERD is a condition characterized by regurgitation of gastric contents into the esophagus or the mouth, resulting in troublesome symptoms or complications NA NA
2 NERD is a subcategory of GERD. It is characterized by troublesome reflux symptoms with abnormally increased gastroesophageal reflux observed on 24-hour ambulatory pH-impedance monitoring in the absence of esophageal mucosal injury confirmed on endoscopy NA NA
3 Reflux hypersensitivity is defined as retrosternal symptoms, including heartburn or chest pain triggered by physiological reflux in the absence of abnormally increased gastroesophageal reflux NA NA
4 Functional heartburn is defined as retrosternal burning discomfort or pain refractory to acid-suppressive therapy in the absence of GERD NA NA
5 Refractory GERD is defined as GERD symptoms unresponsive to the administration of ≥ 8 weeks of a standard dose of an acid-suppressive agent NA NA
6 GERD can cause various extra-esophageal symptoms such as cough, asthma, hoarseness, or non-cardiac chest pain. Extra-esophageal GERD symptoms may or may not be accompanied by typical GERD symptoms NA NA
7 The prevalence of GERD is increasing in Asian countries Moderate NA
Diagnosis of GERD
8 Symptom-based diagnostic questionnaires are useful for the accurate diagnosis of GERD Low Weak
9 A 2-week trial of a standard dose of PPI should be recommended as a sensitive and practical test for GERD diagnosis in patients with typical GERD symptoms Moderate Strong
10 Endoscopy with or without biopsy can be recommended to diagnose GERD and exclude other organic diseases Very low Strong
11 Endoscopic surveillance is recommended in patients with long-segment Barrett’s esophagus Very low Strong
12 Twenty-four-hour ambulatory pH-impedance monitoring is indicated in patients with GERD symptoms that are refractory to PPI therapy. This test is also recommended before anti-reflux surgery Very low Strong
13 A value of the total esophageal acid exposure time of ≥ 4% is defined as an abnormal finding in Asian adults Moderate Weak
14 Esophageal manometry is useful in the assessment of peristaltic function and exclusion of alternative motility disorders. Therefore, esophageal manometry should be performed before anti-reflux surgery in patients with GERD Low Strong
15 Novel impedance parameters, including baseline impedance and post-reflux swallow-induced peristaltic wave, are promising in the GERD diagnosis and increase GERD diagnostic yield Low Weak
Treatment of GERD
16 Weight reduction is recommended to improve GERD symptoms in overweight patients or those diagnosed with obesity Moderate Strong
17 The administration of a standard dose of PPI once a day for 4 to 8 weeks is recommended as the initial treatment of GERD High Strong
18 Double-dose PPI therapy may be effective in patients with GERD who do not show an adequate response to standard-dose PPI therapy Moderate Weak
19 On-demand PPI therapy’s effectiveness is comparable with that of continuous daily PPI therapy for the long-term management of patients with NERD or mild erosive reflux disease Moderate Weak
20 PPI therapy is recommended to treat NCCP in patients who present with concomitant typical GERD symptoms Moderate Strong
21 The effect of P-CABs is comparable with that of PPIs for the initial treatment of patients with GERD Moderate Strong
22 Anti-reflux surgery can be recommended as an alternative to PPI maintenance therapy to improve symptoms and quality of life in patients with proven GERD Moderate Weak

GERD, gastroesophageal reflux disease; NERD, non-erosive reflux disease; PPI, proton pump inhibitor; NCCP, non-cardiac chest pain; P-CABs, potassium-competitive acid blockers; NA, not applicable.

J Neurogastroenterol Motil 2021;27:453~481
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