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

"OBJECTIVE: Since the publication of the Asia-Pacific consensus on gastro-oesophageal reflux disease in 2008, there has been further scientific advancement in this field. This updated consensus focuses on proton pump inhibitor-refractory reflux disease and Barrett's oesophagus. METHODS: A steering committee identified three areas to address: (1) burden of disease and diagnosis of reflux disease; (2) proton pump inhibitor-refractory reflux disease; (3) Barrett's oesophagus. Three working groups formulated draft statements with supporting evidence. Discussions were done via email before a final face-to-face discussion. We used a Delphi consensus process, with a 70% agreement threshold, using Grading of Recommendations Assessment, Development and Evaluation (GRADE) criteria to categorise the quality of evidence and strength of recommendations. RESULTS: A total of 32 statements were proposed and 31 were accepted by consensus. A rise in the prevalence rates of gastro-oesophageal reflux disease in Asia was noted, with the majority being non-erosive reflux disease. Overweight and obesity contributed to the rise. Proton pump inhibitor-refractory reflux disease was recognised to be common. A distinction was made between refractory symptoms and refractory reflux disease, with clarification of the roles of endoscopy and functional testing summarised in two algorithms. The definition of Barrett's oesophagus was revised such that a minimum length of 1 cm was required and the presence of intestinal metaplasia no longer necessary. We recommended the use of standardised endoscopic reporting and advocated endoscopic therapy for confirmed dysplasia and early cancer. CONCLUSIONS: These guidelines standardise the management of patients with refractory gastro-oesophageal reflux disease and Barrett's oesophagus in the Asia-Pacific region."

Evaluation of the use of rapid urease test: Pronto Dry to detect H pylori in patients with dyspepsia in several cities in Indonesia.

AIM: To evaluate Pronto Dry examination in patients with dyspepsia. METHODS: The study was conducted in patients with dyspepsia who underwent endoscopic examination in several endoscopic centers of several cities in Indonesia from January 2003 until April 2004. Biopsies for histopathologic examination were fixed with formalin and sent to Histopathologic Department to be analyzed and confirm the presence of H pylori infection. If H pylori was found positive, the density was calculated semi quantitatively. Histopathologic examination from gastric biopsy samples was interpreted based on the updated Sydney system classification. RESULTS: Of 550 patients, 309 (56%) were male and 241 (44%) were female with ages ranging from 15 to 82 years. Mean age was 44.98 +/- 14.46 years. Mean age of male patients was 44.35 +/- 13.85 years and mean age of female patients was 45.78 +/- 15.19 years. Evaluation of endoscopic results showed gastric ulcer in 36 cases (6.5%) and duodenal ulcer in 20 cases (3.6%). Normal endoscopic finding was found in 45 cases (8.2%) and minimal disorder of gastritis and duodenitis were found in 246 cases (44.7%). One case of gastric cancer was identified. Of 56 cases which were positive based on the criteria used, 39 patients were positive with Pronto Dry and 17 patients were negative with Pronto Dry. Overall sensitivity and specificity of Pronto Dry were 69.7% and 95.7% respectively. Positive predictive value was 66.1% and negative predictive value was 96.4% and overall accurate rate was 92.9%. CONCLUSION: Pronto Dry seems promising as a diagnostic tool to detect H pylori more rapidly and accurately.