An important consensus statement on the management of gastroesophageal reflux disease for the largest population in the world
Notice bibliographique
Résumé
A group of distinguished experts from the Asia–Pacific area have developed an updated consensus on the management of gastroesophageal reflux disease (GERD).1 Although four of the 18 participants also were involved in the global consensus group of the Montreal definition and classification of GERD,2 the definition of Barrett's esophagus is different, as is the extensive focus on the treatment of GERD, accounting for 11 of 38 statements. The level of consensus of the statements is impressive. Even if the level of acceptance of a statement was only “accept completely” or “accept with some reservation”, and not “accept with major reservation”, as defined in the manuscript, acceptance was 85%. After a subgroup discussion of statements and then presentation to the entire consensus group, keypad voting was done to ensure anonymity and avoid the peer pressure of hand or voice voting. One of the unique features of the Asia–Pacific region is the high prevalence of peptic ulcer disease and gastric cancer attributable to the endemic nature of Helicobacter pylori infection. This was especially important in five diagnostic statements considering the role of endoscopy. The role of endoscopy becomes focused on the detection of peptic ulcer and gastric cancer contrasted to the detection of Barrett's esophagus in Western countries. Related to this issue is the recognition of the problem of the overlap of symptoms of different upper gastrointestinal (GI) disorders; that is, the imprecise clinical separation of chronic upper GI symptoms of GERD and peptic ulcer. For example, “heartburn” is a word with no equivalent in any of the Asian languages. Establishing H. pylori status plays a more prominent role in Asia than in Western countries given the prevalence of H. pylori and its resultant peptic ulcer and gastric cancer. The algorithm for the management of reflux symptoms accompanied by alarm features includes H. pylori testing. Compared to the Montreal definition and the British Society of Gastroenterology Guidelines,3 the Asia–Pacific definition of Barrett's esophagus is “the presence of columnar lined epithelium suspected at endoscopy and proven by histology which requires the presence of intestinal metaplasia” with a 94% level of agreement of “accept completely”.1 The Montreal term of “endoscopically suspected esophageal metaplasia” was rejected because of non-sustainability in the Asian context of low prevalence of Barrett's esophagus. Specificity is important for a low prevalence disease in a massive population. Even though GERD is a growing medical problem in Asia, it is less prevalent than in Western countries, and the frequency of esophageal mucosal disease is also less. In fact, non-erosive reflux disease is a larger proportion of GERD in Asia versus Western countries.4 There is agreement on the use of antireflux surgery for GERD patients wanting to stop medical therapy. However, not mentioned is a positive indication for surgery; that is, volume reflux.5 Bothersome regurgitation, even to the point of aspiration pneumonia, may occur even on high-dose proton pump inhibitor therapy. The participants of this Asia–Pacific GERD management consensus are to be congratulated on their complete and thorough consideration of the issues. The prognostic statements can serve as a guide to the practical management of GERD for the region.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,072 | 0,142 |
| Méta-épidémiologie (sens strict) | 0,002 | 0,001 |
| Méta-épidémiologie (sens large) | 0,003 | 0,004 |
| Bibliométrie | 0,004 | 0,002 |
| Études des sciences et des technologies | 0,003 | 0,003 |
| Communication savante | 0,007 | 0,005 |
| Science ouverte | 0,006 | 0,007 |
| Intégrité de la recherche | 0,017 | 0,021 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,012 | 0,013 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».