Asia-Pacific consensus on the management of gastro-oesophageal reflux disease: an update focusing on refractory reflux disease and Barrett's oesophagus

The added diagnostic value of postreflux swallow‐induced peristaltic wave index and nocturnal baseline impedance in refractory reflux disease studied with on‐therapy impedance‐pH monitoring

“…We documented positive surgical outcome in 91% of 58 patients with PPI–refractory typical GERD, a result similar to those reported in PPI‐responsive typical GERD and comparable to the efficacy of PPIs in confirming GERD in patients with uninvestigated or endoscopy‐negative heartburn . Given the high efficacy of laparoscopic fundoplication in PPI‐responsive GERD, in PPI‐refractory GERD positive surgical outcome confirms the pre‐operative diagnosis . Therefore, we considered positive surgical outcome as the standard of accuracy for confirming PPI‐refractory GERD, pre‐operatively documented by abnormal conventional impedance‐pH variables.…”

“…At multivariate logistic regression analysis, the PSPW index resulted an independent predictor of PPI‐refractory GERD as confirmed by positive surgical outcome. Despite the efficacy of laparoscopic fundoplication, side effects have limited its utilization: therefore, a firm diagnosis of PPI–refractory GERD is warranted before advising surgery . Our results suggest that low values of PSPW index in PPI‐refractory heartburn patients studied with on‐therapy impedance‐pH monitoring can increase our confidence in distinguishing PPI‐refractory GERD from FH and in advising antireflux interventions.…”

“…A cause‐and‐effect relationship between PPI‐refractory heartburn and reflux should be documented before advising antireflux interventions . The limitations of AET at on‐PPI impedance‐pH testing have long been recognized .…”

“…to distinguish non‐erosive reflux disease (NERD) from functional heartburn (FH) . On‐PPI testing has been recommended when patients complain of PPI‐refractory heartburn because the pretest likelihood of GERD is high, given the specificity of the symptom; by on‐therapy testing, the mechanisms of PPI refractoriness can be clarified and positive surgical outcome can be predicted when a direct relationship between persistent heartburn and reflux is documented . However, on‐therapy studies assessing all conventional impedance‐pH variables, namely the symptom association probability (SAP), the symptom index (SI), the esophageal acid exposure time (AET), and the number of reflux events afforded controversial results .…”

Improved diagnostic stratification of digitised Barrett's oesophagus biopsies by p53 immunohistochemical staining

“…Histopathological diagnosis of low‐grade dysplasia (LGD) is the only accepted predictor for progression . However, this is complicated by interobserver variability between pathologists, and conflicting results in reporting rates of progression to OAC for LGD have been reported . Studies suggest that, when LGD is confirmed by an expert pathologist, the risk of progression increases sharply .…”