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Oesophagus
Original research
Application of Lyon Consensus criteria for GORD diagnosis: evaluation of conventional and new impedance-pH parameters
  1. Leonardo Frazzoni1,
  2. Marzio Frazzoni2,
  3. Nicola De Bortoli3,
  4. Mentore Ribolsi4,
  5. Salvatore Tolone5,
  6. Salvatore Russo2,
  7. Rita Luisa Conigliaro6,
  8. Roberto Penagini7,
  9. Lorenzo Fuccio1,
  10. Rocco Maurizio Zagari1,
  11. Edoardo Savarino8
  1. 1Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna Policlinico S Orsola-Malpighi, Bologna, Italy
  2. 2Digestive Pathophysiology Unit, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
  3. 3Department of New Technologies and Translational Research in Medicine and Surgery, University of Pisa, Pisa, Italy
  4. 4Digestive Disease, Università Campus Bio-Medico di Roma Facoltà Dipartimentale di Medicina e Chirurgia, Roma, Italy
  5. 5General and Bariatric Surgery Unit, Department of Surgery, Seconda Università degli Studi di Napoli Facoltà di Medicina e Chirurgia, Caserta, Italy
  6. 6Digestive Endoscopy Unit, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Italy
  7. 7Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
  8. 8Department of Surgery, Oncology and Gastroenterology, University of Padua School of Medicine and Surgery, Padova, Italy
  1. Correspondence to Dr Marzio Frazzoni, Digestive Pathophysiology Unit, Azienda Ospedaliero-Universitaria di Modena Ospedale Civile di Baggiovara, Modena, Emilia-Romagna, Italy; marziofrazzoni{at}gmail.com

Abstract

Objective To validate Lyon Consensus criteria for diagnosing gastro-oesophageal reflux disease (GORD) by reflux monitoring.

Design Manual review of impedance-pH tracings from patients with proton pump inhibitor (PPI)-dependent heartburn, evaluated off PPI. Acid exposure time (AET) thresholds defined by the Lyon Consensus and impedance parameters were investigated, namely, total refluxes (TRs), postreflux swallow-induced peristaltic wave (PSPW) index and mean nocturnal baseline impedance (MNBI).

Results The study included 488 patients, 178 (36%) with normal (<4%) AET, 89 (18%) with inconclusive (4%–6%) AET and 221 (45%) with abnormal (>6%) AET, alongside with 70 healthy controls. At receiver operating characteristic analysis, area under curve was 0.89, 0.95 and 0.89 for TRs, PSPW index and MNBI, respectively, and threshold values were 40, 50% and 2000 Ω; the 4% physiological AET threshold defined by the Lyon Consensus showed 100% specificity but 63% sensitivity. The thresholds defined for impedance parameters were validated against AET by means of ordered logistic regression, being in concordance with the 4% AET threshold (OR 2.5 for TRs, 18.9 for PSPW index and 5.7 for MNBI). TRs positivity and concordant PSPW index/MNBI positivity were found in 80%–90% of patients in the abnormal AET group, in 73%–74% of cases in the inconclusive AET group and in 28%–40% of cases in the group with normal AET.

Conclusions Our results show the overall validity of the Lyon Consensus approach to GORD diagnosis. Adding evaluation of impedance parameters, namely, TRs, PSPW index and MNBI to AET appraisal, substantially improves the diagnostic yield of reflux monitoring.

  • acid-related diseases
  • oesophageal ph monitoring
  • gastroesophageal reflux disease

Data availability statement

Data supporting the study are available on reasonable request from the corresponding author.

https://doi.org/10.1136/gutjnl-2021-325531

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    Data availability statement

    Data supporting the study are available on reasonable request from the corresponding author.

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    Footnotes

    • Contributors LF: study concept and design; analysis and interpretation of data; drafting of the manuscript. MF: study concept and design; collection, analysis and interpretation of data; drafting of the manuscript. NDB, MR, ES: study concept; collection, analysis and interpretation of data; critical revision of the manuscript. ST, SR, RLC: collection, analysis and interpretation of data; critical revision of the manuscript. RP, LF, RMZ: study concept; analysis and interpretation of data; critical revision of the manuscript.

    • 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 Not commissioned; externally peer reviewed.