Journal article

Modern diagnosis of GERD: the Lyon Consensus.

  • Gyawali CP Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA.
  • Kahrilas PJ Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA.
  • Savarino E Division of Gastroenterology, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padua, Padua, Italy.
  • Zerbib F Department of Gastroenterology, Bordeaux University Hospital, Université de Bordeaux, Bordeaux, France.
  • Mion F Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France.
  • Smout AJPM Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
  • Vaezi M Division of Gastroenterology, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
  • Sifrim D Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
  • Fox MR Gastroenterology, St. Claraspital, Kleinriehenstrasse 30, Basel, Switzerland.
  • Vela MF Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA.
  • Tutuian R Division of Gastroenterology, University Clinics for Visceral Surgery and Medicine, Bern University Hospital, Bern, Switzerland.
  • Tack J Department of Gastroenterology, Catholic University of Leuven, Leuven, Belgium.
  • Bredenoord AJ Department of Gastroenterology and Hepatology, Academic Medical Center, Amsterdam, The Netherlands.
  • Pandolfino J Division of Gastroenterology, Department of Medicine, Northwestern University, Chicago, Illinois, USA.
  • Roman S Digestive Physiology, Hopital E Herriot, Hospices Civils de Lyon, Université de Lyon, Lyon, France.
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  • 2018-02-14
Published in:
  • Gut. - 2018
English Clinical history, questionnaire data and response to antisecretory therapy are insufficient to make a conclusive diagnosis of GERD in isolation, but are of value in determining need for further investigation. Conclusive evidence for reflux on oesophageal testing include advanced grade erosive oesophagitis (LA grades C and D), long-segment Barrett's mucosa or peptic strictures on endoscopy or distal oesophageal acid exposure time (AET) >6% on ambulatory pH or pH-impedance monitoring. A normal endoscopy does not exclude GERD, but provides supportive evidence refuting GERD in conjunction with distal AET <4% and <40 reflux episodes on pH-impedance monitoring off proton pump inhibitors. Reflux-symptom association on ambulatory reflux monitoring provides supportive evidence for reflux triggered symptoms, and may predict a better treatment outcome when present. When endoscopy and pH or pH-impedance monitoring are inconclusive, adjunctive evidence from biopsy findings (histopathology scores, dilated intercellular spaces), motor evaluation (hypotensive lower oesophageal sphincter, hiatus hernia and oesophageal body hypomotility on high-resolution manometry) and novel impedance metrics (baseline impedance, postreflux swallow-induced peristaltic wave index) can add confidence for a GERD diagnosis; however, diagnosis cannot be based on these findings alone. An assessment of anatomy, motor function, reflux burden and symptomatic phenotype will therefore help direct management. Future GERD management strategies should focus on defining individual patient phenotypes based on the level of refluxate exposure, mechanism of reflux, efficacy of clearance, underlying anatomy of the oesophagogastric junction and psychometrics defining symptomatic presentations.
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  • English
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hybrid
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https://sonar.ch/global/documents/58231
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