In the last two decades gastroesophageal reflux disease (GERD), initially thought to be a disease only common in the West, is described increasingly in Asia, including the Philippines. A recent local report indicated that the prevalence of erosive esophagitis (EE), a common complication of GERD, has more than doubled, i.e., 2.9% to 6.3%, between the two time periods of 1994–1997 and 2000–2003, respectivel y . GERD causes recur rent annoying symptoms which are common reasons for clinic visits and consultations thus, it is the objective of these guidelines to provide both primary care physicians (PCPs) and specialists a current, evidence-based, country-specific recommendations for the optimal management of GERD. These guidelines are intended to empower PCPs to make a clinic-based diagnosis of GERD, to start an empiric acid-suppressive therapy in the appropriate patient, and direct them to select which GERD patient may need to undergo investigations to ascertain further the diagnosis of GERD or to assess outcomes of therapy. We acknowledge that studies published in the future may influence the impact on our confidence on the recommendations enumerated in these guidelines thus, we commit to update this document when it is deemed appropriate.

Keywords: Gastroesophageal reflux disease, erosive esophagitis, non-erosive reflux disease, refractory GERD, extraesophageal GERD, Barrett’s esophagus, proton pump inhibitor, upper endoscopy, heartburn, acid regurgitation, alarm features   

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147. Hvid-Jensen F, Pedersen L, Funch-Jensen P, et al. Proton pump inhibitor use may not prevent high-grade dysplasia and oesophageal adenocarcinoma in Barrett’s oesophagus: a nationwide study of 9883 patients. Aliment Pharmacol Ther 2014;39:984-91.
148. Jankowski JA, Harrison RF, Perry I, et al. Barrett’s metaplasia. Lancet 2000;356:2079-85.
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150. Yousef F, Cardwell C, Cantwell MM, et al. The incidence of esophageal cancer and high-grade dysplasia in Barrett’s esophagus: a systematic review and meta-analysis. Am J Epidemiol 2008;168:237-49.
151. Anderson LA, Murray LJ, Murphy SJ, et al. Mortality in Barrett’s oesophagus: results from a population based study. Gut 2003;52:1081-4.
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153. Sheen E, Triadafilopoulos G. Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci 2011;56:931- 50.
154. Targownik LE, Lix LM, Metge CJ, et al. Use of proton pump inhibitors and risk of osteoporosis-related fractures. CMAJ 2008;179:319-26.
155. Yang YX, Lewis JD, Epstein S, et al. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA 2006;296:2947-53.
156. Targownik LE, Lix LM, Leung S, et al. Proton-pump inhibitor use is not associated with osteoporosis or accelerated bone mineral density loss. Gastroenterology 2010;138:896-904.
157. Corley DA, Kubo A, Zhao W, et al. Proton pump inhibitors and histamine-2 receptor antagonists are associated with hip fractures among at-risk patients. Gastroenterology 2010;139:93-101.
158. Ngamruengphong S, Leontiadis GI, Radhi S, et al. Proton pump inhibitors and risk of fracture: a systematic review and meta-analysis of observational studies. Am J Gastroenterol 2011;106:1209-18; quiz 1219.
159. Dial MS. Proton pump inhibitor use and enteric infections. Am J Gastroenterol 2009;104 Suppl 2:S10-6.
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175. Zhou LY, Lin SR, Ding SG, et al. The changing trends of the incidence of gastric cancer after Helicobacter pylori eradication in Shandong area. Chin J Dig Dis 2005;6:114- 5.
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179. Spechler SJ, Sharma P, Souza RF, et al. American Gastroenterological Association technical review on the management of Barrett’s esophagus. Gastroenterology 2011;140:e18-52; quiz e13.
180. Eloubeidi MA, Provenzale D. Clinical and demographic predictors of Barrett’s esophagus among patients with gastroesophageal reflux disease: a multivariable analysis in veterans. J Clin Gastroenterol 2001;33:306-9.
181. Gilani N, Gerkin RD, Ramirez FC, et al. Prevalence of Barrett’s esophagus in patients with moderate to severe erosive esophagitis. World J Gastroenterol 2008;14:3518-22.
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184. Wileman SM, McCann S, Grant AM, et al. Medical versus surgical management for gastro-oesophageal reflux disease (GORD) in adults. Cochrane Database Syst Rev 2010:CD003243.
185. Lundell L, Miettinen P, Myrvold HE, et al. Comparison of outcomes twelve years after antireflux surgery or omeprazole maintenance therapy for reflux esophagitis. Clin Gastroenterol Hepatol 2009;7:1292-8; quiz 1260.
186. Broeders JA, Roks DJ, Ahmed Ali U, et al. Laparoscopic anterior 180-degree versus nissen fundoplication for gastroesophageal reflux disease: systematic review and meta-analysis of randomized clinical trials. Ann Surg 2013;257:850-9.
187. Tan G, Yang Z, Wang Z. Meta-analysis of laparoscopic total (Nissen) versus posterior (Toupet) fundoplication for gastro-oesophageal reflux disease based on randomized clinical trials. ANZ J Surg 2011;81:246-52.
188. Ma S, Qian B, Shang L, et al. A meta-analysis comparing laparoscopic partial versus Nissen fundoplication. ANZ J Surg 2012;82:17-22.
189. Ramos RF, Lustosa SA, Almeida CA, et al. Surgical treatment of gastroesophageal reflux disease: total or partial fundoplication? systematic review and meta-analysis. Arq Gastroenterol 2011;48:252-60.
190. Oelschlager BK, Quiroga E, Parra JD, et al. Long-term outcomes after laparoscopic antireflux surgery. Am J Gastroenterol 2008;103:280-7; quiz 288.
191. Iqbal M, Batch AJ, Spychal RT, et al. Outcome of surgical fundoplication for extraesophageal (atypical) manifestations of gastroesophageal reflux disease in adults: a systematic review. J Laparoendosc Adv Surg Tech A 2008;18:789-96.
192. Mazzini Gda S, Gurski RR. Impact of laparoscopic fundoplication for the treatment of laryngopharyngeal reflux: review of the literature. Int J Otolaryngol 2012;2012:291472.
193. Pandolfino JE, Kahrilas PJ, American Gastroenterological A. AGA technical review on the clinical use of esophageal manometry. Gastroenterology 2005;128:209-24.
194. Sifrim D, Castell D, Dent J, et al. Gastro-oesophageal reflux monitoring: review and consensus report on detection and definitions of acid, non-acid, and gas reflux. Gut 2004;53:1024-31.
195. Conchillo JM, Schwartz MP, Selimah M, et al. Role of intra-oesophageal impedance monitoring in the evaluation of endoscopic gastroplication for gastro-oesophageal reflux disease. Aliment Pharmacol Ther 2007;26:61-8.
196. Cicala M, Gabbrielli A, Emerenziani S, et al. Effect of endoscopic augmentation of the lower oesophageal sphincter (Gatekeeper reflux repair system) on intraoesophageal dynamic characteristics of acid reflux. Gut 2005;54:183-6.
197. Cohen LB, Johnson DA, Ganz RA, et al. Enteryx implantation for GERD: expanded multicenter trial results and interim postapproval follow-up to 24 months. Gastrointest Endosc 2005;61:650-8.
198. Deviere J, Costamagna G, Neuhaus H, et al. Nonresorbable copolymer implantation for gastroesophageal reflux disease: a randomized sham-controlled multicenter trial. Gastroenterology 2005;128:532-40.
199. Mahmood Z, McMahon BP, Arfin Q, et al. Endocinch therapy for gastro-oesophageal reflux disease: a one year prospective follow up. Gut 2003;52:34-9.
200. Triadafilopoulos G, Dibaise JK, Nostrant TT, et al. Radiofrequency energy delivery to the gastroesophageal junction for the treatment of GERD. Gastrointest Endosc 2001;53:407-15.
201. Bonavina L, Saino G, Lipham JC, et al. LINX((R)) Reflux Management System in chronic gastroesophageal reflux: a novel effective technology for restoring the natural barrier to reflux. Therap Adv Gastroenterol 2013;6:261-8.
202. Lipham JC, DeMeester TR, Ganz RA, et al. The LINX(R) reflux management system: confirmed safety and efficacy now at 4 years. Surg Endosc 2012;26:2944-9.
203. Testoni PA, Vailati C, Testoni S, et al. Transoral incisionless fundoplication (TIF 2.0) with EsophyX for gastroesophageal reflux disease: long-term results and findings affecting outcome. Surg Endosc 2012;26:1425-35.
204. Fleischer DE, Overholt BF, Sharma VK, et al. Endoscopic radiofrequency ablation for Barrett’s esophagus: 5-year outcomes from a prospective multicenter trial. Endoscopy 2010;42:781-9.
205. Shaheen NJ, Sharma P, Overholt BF, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med 2009;360:2277-88.