Table 4

GERD phenotypes predicting abnormal reflux burden from clinical evaluation and oesophageal testing

Pathological GERD
High likelihoodIntermediate likelihoodLow likelihoodModifiers
Clinical phenotypes
 SymptomsHeartburn, acid regurgitationChest painCough, laryngeal symptomsHypersensitivity and hypervigilance
 EndoscopyHigh-grade oesophagitis, Barrett’s mucosa, peptic strictureLow-grade oesophagitis, normal exam on PPI therapyHiatus hernia, ongoing PPI therapy
 ROME IVNERD (abnormal pH-metry)*Symptom response to PPI therapyReflux hypersensitivity functional heartburn, functional chest painHypersensitivity and hypervigilance
 Lyon Consensus*Conclusive evidence of GERDBorderline or inconclusive evidencePhysiological reflux parametersNovel metrics
Motor classification
Mechanistic phenotypes
 Pattern of refluxIncreased acid exposure
±increased numbers of reflux episodes*
Borderline acid exposure±borderline numbers of reflux episodes*Normal reflux metricspH of refluxate, baseline impedance, hypochlorhydria, achlorhydria
 Mechanism of refluxTLESR
Hypotensive EGJ
Abnormal EGJ morphology
Supragastric belch
Normal EGJ morphology and functionObesity, increased abdominal girth
 Clearance of refluxateAbsent contractility
Hiatus hernia
Minor motor disorder±contraction reserveNormal peristalsisXerostomia, baseline impedance, PSPW index, motor classification
 Cognition, perception of sensationAppropriate symptom perception, symptom reflux associationIncreased perceptionVisceral hypersensitivity, hypervigilanceAnxiety, depression
Panic disorder
  • *As described by the Lyon Consensus, figure 3.

  • EGD, oesophagogastroduodenoscopy; EGJ, oesophagogastric junction; NERD, non-erosive reflux disease; PSPW, postreflux swallow-induced peristaltic wave; TLESR, transient lower oesophageal sphincter relaxation.