Modern diagnosis of GERD: the Lyon Consensus

Abstract

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.

Fragmented and failed swallows on esophageal high‐resolution manometry associate with abnormal reflux burden better than weak swallows

“…8 Mean nocturnal baseline impedance (MNBI) was the averaged baseline impedance calculated at the 3-cm and 5-cm channels at three stable nocturnal time periods 8 Mean nocturnal baseline impedance (MNBI) was the averaged baseline impedance calculated at the 3-cm and 5-cm channels at three stable nocturnal time periods…”

“…2 Inadequate refluxate clearance can involve various elements of esophageal motor function, including inability to initiate primary or secondary peristalsis, impaired or absent peristaltic sequences, and abnormal esophagogastric junction (EGJ) morphology. 7,8 Hypomotility patterns on esophageal HRM, including fragmented peristalsis, ineffective esophageal motility (IEM), and absent contractility, have been linked to abnormal reflux clearance. 7,8 Hypomotility patterns on esophageal HRM, including fragmented peristalsis, ineffective esophageal motility (IEM), and absent contractility, have been linked to abnormal reflux clearance.…”

“…11 However, reflux clearance can be abnormal even when peristalsis is intact, especially when there are breaks in peristaltic integrity in the esophageal body. Using esophageal acid exposure time (AET) and mean nocturnal baseline impedance (MNBI) as metrics defining esophageal reflux burden, 8 we compared the reflux implications of various proportions of fragmented, weak, and failed peristalsis as part of the standard HRM swallow protocol. Using esophageal acid exposure time (AET) and mean nocturnal baseline impedance (MNBI) as metrics defining esophageal reflux burden, 8 we compared the reflux implications of various proportions of fragmented, weak, and failed peristalsis as part of the standard HRM swallow protocol.…”

Management of supragastric belching with cognitive behavioural therapy: factors determining success and follow‐up outcomes at 6‐12 months post‐therapy

“…23 Linear regression analysis of the impedance-pH parameters showed that only the initial number of SGBs was significantly associated with percentage change in VAS score (Table 1). The median total number of reflux episodes was 49 (31-82) episodes, in which those of acid reflux was 37 (16-55) episodes.…”

Роль Біологічно Активних Речовин У Формуванні Гастроезофагеальної Рефлюксної Хвороби У Хворих На Цукровий Діабет 2 Типу

“…В.Н. Чернобрового) [7]. Для ендоскопічної оцінки ступеня ураження стравоходу використовували Лос-Анджелеську (LA) класифіка-цію (1998).…”