The Lyon Consensus 2.0 has introduced updated criteria for diagnosing gastro-oesophageal reflux disease (GERD), focusing on the necessity of conclusive evidence from oesophageal testing to support diagnosis and management.
THIS INTERNATIONAL EXPERT group has refined the definition of actionable GERD, which now requires clear evidence of reflux-related pathology alongside troublesome symptoms.
KEY UPDATES AND DIAGNOSTIC CRITERIA
One of the significant updates includes recognising Los Angeles grade B oesophagitis as definitive evidence of GERD. The consensus differentiates between proven and unproven GERD and establishes specific testing strategies based on symptom presentation. For patients with unproven GERD, prolonged wireless pH monitoring or catheter-based pH monitoring is recommended. In contrast, those with proven GERD and ongoing symptoms should undergo pH-impedance monitoring while on optimised antisecretory therapy.
The consensus emphasises the importance of personalising GERD management according to individual patient presentations and improving specificity in diagnostic algorithms. Symptoms are categorised by their likelihood of being related to reflux episodes, with typical symptoms like heartburn and regurgitation being more closely associated with GERD than atypical symptoms such as chronic cough or hoarseness.
DIAGNOSTIC TESTING AND SYMPTOM ASSESSMENT
The document highlights the complexity of diagnosing and managing GERD, advocating for thorough assessments of symptoms and appropriate diagnostic testing. Endoscopy is crucial for accurately assessing oesophageal damage, particularly after discontinuing proton pump inhibitor (PPI) therapy. The Los Angeles classification system is used to categorise esophagitis, with grades B, C, and D being conclusive for GERD.
Prolonged wireless pH monitoring is emphasised as a preferred method for diagnosing GERD, with metrics like Acid Exposure Time (AET) being critical in determining the need for continued PPI therapy or further management strategies. The document also discusses the management of refractory GERD, suggesting that pH-impedance monitoring can help identify patients who may benefit from surgical interventions when medical management fails.
SYMPTOM REMINDER
Typical symptoms of GERD consist of: heartburn, oesophageal chest pain and regurgitation. The relationship of belching to reflux disease is variable, but belching can be part of reflux pathophysiology.
Chronic cough and wheezing have a low but potential pathophysiological relationship to reflux disease.
Hoarseness, globus, nausea, abdominal pain and other dyspeptic symptoms in the absence of typical symptoms have a low likelihood of pathophysiological relationship to reflux disease.
REFERENCE
Gyawali CP, Yadlapati R, Fass R, et al. Updates to the modern diagnosis of GERD: Lyon consensus 2.0. Gut 2024;73:361–371.
