Applying Lyon Consensus criteria in the work‐up of patients with proton pump inhibitory‐refractory heartburn

Summary Background A hierarchical approach for gastro‐oesophageal reflux disease (GERD) diagnosis by impedance‐pH monitoring was proposed by the Lyon Consensus, based on acid exposure time (AET) and supportive impedance metrics. Aims To establish the clinical value of Lyon Consensus criteria in the...

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Published in:Alimentary pharmacology & therapeutics 2022-06, Vol.55 (11), p.1423-1430
Main Authors: Frazzoni, Marzio, Frazzoni, Leonardo, Ribolsi, Mentore, Bortoli, Nicola De, Tolone, Salvatore, Russo, Salvatore, Conigliaro, Rita, Penagini, Roberto, Fuccio, Lorenzo, Zagari, Rocco Maurizio, Savarino, Edoardo
Format: Article
Language:English
Subjects:
Consensus
Electric Impedance
Esophageal pH Monitoring
Gastroesophageal reflux
Gastroesophageal Reflux - diagnosis
Gastroesophageal Reflux - drug therapy
GERD
Heartburn - diagnosis
Heartburn - drug therapy
Humans
impedance‐pH monitoring
laparoscopic fundoplication
Patients
pH effects
PPI
Proton Pump Inhibitors - therapeutic use
Proton Pumps - therapeutic use
Remission
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Summary:Summary Background A hierarchical approach for gastro‐oesophageal reflux disease (GERD) diagnosis by impedance‐pH monitoring was proposed by the Lyon Consensus, based on acid exposure time (AET) and supportive impedance metrics. Aims To establish the clinical value of Lyon Consensus criteria in the work‐up of patients with proton pump inhibitory (PPI)‐refractory heartburn. Methods Expert review of off‐therapy impedance‐pH tracings from unproven GERD patients with PPI‐refractory heartburn prospectively evaluated at referral centers. Impedance metrics, namely total reflux episodes, postreflux swallow‐induced peristaltic wave index, and mean nocturnal baseline impedance, were assessed. Expert review of on‐therapy preoperative impedance‐pH tracings from a separate cohort of surgically treated erosive/nonerosive GERD cases. Results Off‐therapy, normal, inconclusive, and abnormal AET was found in 59%, 17%, and 23% of 317 cases. Supportive evidence of GERD was provided by abnormal impedance metrics in up to 22% and 62% of cases in the normal and inconclusive AET groups, respectively. Adding the cases with inconclusive AET and abnormal impedance metrics to the abnormal AET group, a significant increase in GERD evidence was observed (from 23% to 37% of cases, p 
ISSN:0269-2813
1365-2036
DOI:10.1111/apt.16838