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In most patients presenting without alarm features, gastro-oesophageal reflux disease (GORD) is diagnosed empirically, based on symptoms assessment and response to medical therapy, mainly proton pump inhibitors (PPIs). Despite its low specificity (placebo response) and the risk of PPI overuse, the empiric PPI trial is cost-effective and recommended as a first line strategy when GORD is suspected.1 Additional testing is indicated when empiric treatment fails to provide adequate symptom relief and/or prior antireflux surgery. In 2017, the so-called ‘Lyon consensus’ experts proposed guidelines for GORD diagnosis based on the results of endoscopy and ambulatory pH (impedance) monitoring. Briefly, these experts considered as a conclusive diagnosis of GORD the presence of Los Angeles grade C/D oesophagitis, peptic stricture, long-segment Barrett’s mucosa or acid exposure time (AET) superior to 6% on pH monitoring. An AET below 4% is considered as definitely normal, and consequently, the experts acknowledged the possibility of an inconclusive diagnosis in patients with an AET between 4% and 6%: the ‘grey area’. In this situation, considering additional parameters (baseline impedance, histology, oesophageal motility abnormalities) may help to shrink this area as much as possible.
In Gut, Rusu et al report the results of a study …
Contributors FZ wrote alone this commissioned commentary.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Commissioned; internally peer reviewed.