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

Summary 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. Results 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.