Normal acid exposure time in esophageal pH monitoring in Asian and Western populations: A systematic review and meta‐analysis

Kim, Seung Young; Jung, Hye‐Kyung; Lee, Hye Ah

doi:10.1111/nmo.14029

Cited by 3 publications

(1 citation statement)

References 103 publications

(110 reference statements)

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“…However, diagnosis/definition of GERD in the 4 included studies were partly different and all classified erosive esophagitis as GERD, which could be contradictory to Lyon Consensus. Although the GERD incidence in Western countries is higher than Asian-Pacific region34 and reflux is commoner in Western populations,35 whether the association between abnormal GEFV and endoscopic confirmed GERD would be more clear remains ambiguous based on current studies, so high-quality investigation need to be carried in Western to reveal the association.…”

Section: Discussionmentioning

confidence: 97%

Association Between Gastroesophageal Flap Valve and Endoscopically Diagnosed Gastroesophageal Reflux Disease According to Lyon Consensus

Bao

Chen

et al. 2021

Journal of Clinical Gastroenterology

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Background: Lyon Consensus altered the previous understanding of endoscopic gastroesophageal reflux disease (GERD) and pointed out that only high-grade reflux esophagitis (RE) [Los Angeles (LA) grades C or D], Barrett’s esophagus or peptic stricturing were considered confirmatory evidence for GERD but low-grade RE (LA grades A or B) was regarded as suspected GERD. We aimed to summarize the possible relationship between gastroesophageal flap valve (GEFV) and endoscopic GERD according to Lyon Consensus using meta-analysis of studies done in Asia. Materials and Methods: Comprehensive searches of PubMed, WOS, Embase, SinoMed, and CNKI databases were completed to identify eligible studies published before September 22, 2019. A total of 237 articles have been reviewed and 2 reviewers independently evaluated the eligibility for inclusion, extracted, and analyzed the statistical data. The pooled risk ratios (RRs) with 95% confidence intervals (CI) were measured for the association. Random-effects models were used when observing significant heterogeneity. Results: A total of 15 studies were included and we found that abnormal GEFV (III and IV) could be associated with RE and the correlation become stronger as the grade increases (RE-A vs. controls—RR: 2.186, 95% CI: 1.560-3.064, P<0.001; RE-B vs. RE-A—RR: 1.268, 95% CI: 1.128-1.425, P<0.001; RE-C vs. RE-B—RR: 1.181, 95% CI: 1.000-1.395, P=0.049; RE-D vs. RE-C—RR: 1.471, 95% CI: 1.151-1.879, P=0.002). Both suspected GERD (RR: 2.400, 95% CI: 1.761-3.271, P<0.001) and endoscopic GERD (RR: 1.388, 95% CI: 1.127-1.711, P=0.002) were related to abnormal GEFV. Conclusion: Abnormal GEFV could provide useful information for reflux conditions, but it could not distinguish confirmatory GERD from low-grade RE under the upper endoscopy.

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Section: Discussionmentioning

confidence: 97%

Association Between Gastroesophageal Flap Valve and Endoscopically Diagnosed Gastroesophageal Reflux Disease According to Lyon Consensus

Bao

Chen

et al. 2021

Journal of Clinical Gastroenterology

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Diagnosis of GORD: is the ‘grey area’ expanding?

Zerbib

2021

Gut

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

Jung¹,

Tae²,

Song³

et al. 2022

Korean J Med

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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.

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Normal acid exposure time in esophageal pH monitoring in Asian and Western populations: A systematic review and meta‐analysis

Cited by 3 publications

References 103 publications

Association Between Gastroesophageal Flap Valve and Endoscopically Diagnosed Gastroesophageal Reflux Disease According to Lyon Consensus

Association Between Gastroesophageal Flap Valve and Endoscopically Diagnosed Gastroesophageal Reflux Disease According to Lyon Consensus

Diagnosis of GORD: is the ‘grey area’ expanding?

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

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