26 WORLD GASTROENTEROLOGY NEWS JANUARY 2016 Gastro 2015: AGW-WGO | Expert Point of View | Gastro 2016: EGHS-WGO | WDHD News | WGO & WGOF News | WGO Global Guidelines | Calendar of Events the symposium titled “Update Man-agement of gastroesophageal reflux disease (GERD): Recent guidelines,” there were three speakers. First Dr. Ari F. Syam, MD, PhD, FACP, from the University of Indonesia in Jakarta, introduced the topic with the GERD-Q and other tools for GERD Diag-nosis. The second speaker, Dr. Putut Bayupurnama, MD, from University of Gajah Mada in Jogjakarta, talked about a cost-effective approach for the treatment of GERD, while the third speaker, Dr. Herry Djagat Poernomo from the University of Diponegoro in Semarang, discussed proton-pump inhibitor (PPI) resistant GERD and extraintestinal GERD. The number of GERD patients has shown a tendency to increase in our community. GERD is a condi-tion that develops when the reflux of stomach contents causes troublesome symptoms (Montreal definition). It occurs when the lower esophageal sphincter (LES) opens spontane-ously for varying periods of time or does not close properly and stomach contents rise up into the esophagus. GERD is also called acid reflux or acid regurgitation because digestive juices called acids rise up with the food. The main symptoms of GERD are heartburn and regurgitation. A 2002 hospital-based study in Jakarta, Indonesia, showed an increas-ing prevalence from 5.7% to 25.18%. According to the GERD-Q, a popu-lation- based survey using symptom-based diagnoses, 6% of the popu-lation suffered from GERD. The GERD-Q is a simple communication tool developed for physicians to identify and manage patients with GERD. The survey was created from three different validated question-naires evaluated in the DIAMOND study. A total of 2,045 subjects com-pleted our last internet survey using the GERD-Q. The prevalence of GERD was 55.4% (31.9% with a low impact on daily life and 23.5% with a high impact on daily life). Male gender, a smoking habit, and BMI less than 30kg/m2 may increase the risk of GERD in our population. The second speaker, Dr. Putut, concluded that the GERD-Q, PPI test, and GERD algorithm are cost-effective approaches to diagnosing GERD with typical symptoms. Endoscopy is only performed in patients with alarm features or selected cases. The third speaker, Dr. Djagat, mentioned that the extraesophageal syndromes consist of established asso-ciations reflux cough syndrome, reflux laryngitis syndrome, reflux asthma syndrome, reflux dental erosion syndrome, and proposed associations (pharyngitis, sinusitis, idiopathic pul-monary fibrosis, and recurrent otitis media). From this definition, we can see that extraesophageal GERD may include ear, nose, throat (ENT), pul-monary (a chronic cough or asthma), or dental symptoms. Sometimes, pa-tients with extraesophageal manifesta-tions do not complain of the ‘typical’ GERD symptoms. Extraesophageal symptoms may be produced by direct acid-pepsin injuries to susceptible supraesophageal tissue. This condition may be mediated through an esopha-geal reflex mechanism. In addition, because most of these patients do not have typical GERD symptoms such as heartburn and regurgitation, the clinician may be unaware that GERD is playing an important role in the symptoms. From this GERD sympo-sium, the audience received informa-tion on how to manage patients with GERD and extraesophageal GERD, especially in daily practice.
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